Significant Landmarks in the History of Aphasia and Its Therapy

CHAPTER© Jones & Bartlett2 Learning, LLC © Jones & Bartlett© Involved Channel/Shutterstock Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Significant© Jones & Bartlett Learning, LLC Landmarks© Jones & Bartlett Learning, LLC inNOT FOR the SALE OR DISTRIBUTIONHistory ofNOT AphasiaFOR SALE OR DISTRIBUTION

OBJECTIVES© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The reader will be able to: 1. Understand the origins of different classifications of aphasia. 2. Compare models of aphasia that have emerged in the history of aphasia. 3.© JonesAppreciate & thatBartlett the history Learning, of aphasia LLC is influenced by social and ©political Jones developments & Bartlett in Learning,different countries. LLC 4. Name the main protagonists in the history of aphasia. 5.NOT Identify FOR the SALE main events OR DISTRIBUTION in the history of aphasia. NOT FOR SALE OR DISTRIBUTION 6. Identify the main shifts in approach to the treatment of aphasia throughout the history of aphasia. 7. Understand where ideas about the nature of aphasia originated.

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION “History doesn’t repeat itself. At best it sometimes Plato’s view, that the mind was located in the head rhymes.” contrasted with Aristotle’s idea that it was located in the heart. With early anatomical examinations of the Mark Twain (1835–1910) brain, the ventricles of the brain, rather than the sub- © Jones & Bartlett Learning, LLCstance of the brain, was© where Jones the & soul Bartlett was consid Learning,- LLC NOT FOR SALE OR DISTRIBUTIONered to reside. This viewNOT lasted FOR well SALE into the OR Middle DISTRIBUTION Introduction Ages. Not until the 15th century were basic treat- In this chapter, we explore where aphasia and ments for aphasia beginning to be developed, based attempts to treat it came from. Along the way, we can on the view that aphasia was a form of memory disor- test© Jones Mark Twain’s & Bartlett pithy aphorism. Learning, We LLCstart with a sur- der. In ©the Jones 18th century, & Bartlett Gall developed Learning, his LLClanguage veyNOT of howFOR thought, SALE language,OR DISTRIBUTION and speech were rep- and speechNOT localization FOR SALE theory, OR and DISTRIBUTION Broca, Hughlings resented in the body from ancient to modern times. Jackson, and Bastian began to consider that recovery The ancient Egyptians thought that the heart was the occurred because of some form of reorganization and seat of the “soul” and mental life, and pre-Christian treatment could be beneficial. But not until the First © Jones & BartlettGreece andLearning, Rome developed LLC a theory of “fluids.”© Jones World & Bartlett War did Learning, Goldstein, LLCLuria, and the Viennese NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 15

phoniatricians Hermann Gutzmann (1865–1922; © Jones & Bartlett Learning, LLC © JonesThe Theory & Bartlett of Learning, Fluids LLC the father of aphasia therapy) and Emil Froeschels NOTThe FOR causes SALE of diseases OR DISTRIBUTIONin ancient times were thought NOT FORdevelop SALE the ORfirst DISTRIBUTION systematic treatments. to be due to some imbalance of the bodily fluids cor- Between the world wars, the focus shifted to responding to the four basic elements, from which all North America, and a more behaviorist approach matter was considered to be made, a view that was to developed. Following World War II, there was a © Jones & Bartlett Learning,persist LLC into the 18th century. This© Jones four-element & Bartlett theory Learning, LLC return to localization theory and an approach to treat- was developed by different philosophers within natu- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ment developed based on the Boston School and the ral philosophy (e.g., Empedocles, 2504–2433 BP) in “stimulation” approaches of Wepman and Schuell. In an attempt to understand nature and the essence of the latter part of the 20th century, approaches were human nature. The four bodily fluids and their cor- developed based on linguistics, psycholinguistics, responding elements were yellow bile (air), blood modular© Jonescognitive & models,Bartlett and Learning, psychosocial LLC and (fire), phlegm© (earth), Jones and & Bartlettblack bile Learning,(water). Healing LLC social models.NOT FOR SALE OR DISTRIBUTION involved manipulatingNOT FOR the SALE balance OR of DISTRIBUTIONfluids: blood- The history of aphasia is vast, and we cannot letting, starvation, fluid deprivation, heat treatment, hope to cover it completely in a single chapter. regurgitation, fecal evacuation, and sweating. Deficits More detailed treatments are available (Eling, 1994; following brain injuries were interpreted as an accu- © JonesTesak & Bartlett & Code, Learning,2008; Howard LLC & Hatfield, 1987). © Jonesmulation & of Bartlett undesirable Learning, life fluids. LLC Cranial drillings NOT FOR SALE OR DISTRIBUTION NOT(trepanations) FOR SALE were OR attempts DISTRIBUTION at the evacuation of undesirable fluids and in some cases may have been Aphasia in the Ancient effective. Past The Greco-Roman Period An understanding of the© Jonespast history & Bartlett of any field Learning, is LLC © Jones & Bartlett Learning, LLC The connection between cognitive processing and a essential to an appreciationNOT of FOR the present;SALE ORthe presDISTRIBUTION- NOT FOR SALE OR DISTRIBUTION possible localization in the structure of the human ent, after all, is the realization of events in the past. body emerged in Greco-Roman times, and the ques- St. Augustine (1,400 years before the present, hence- tion was posed: Was the mind represented in the brain forth BP) outlined a first understanding of what time or in the heart? For Plato (2428–2347 BP), a tripartite past, time© Jones present, & Bartlettand time Learning,future might LLC be. He soul corresponded© Jones to anatomically & Bartlett different Learning, parts LLC of contendedNOT that FOR we SALEcan really OR know DISTRIBUTION only the pres- the body. ReasonNOT and FOR mind SALE were locatedOR DISTRIBUTION in the head, ent because time past is only memory—even if it is but “higher” characteristics, such as pride, fear, and recorded memory (and we know how unreliable courage, were in the heart; the lower characteristics of memory can be)—and time future is, by definition, lust and desire were located in the liver or the abdo- impossible to know. For the history of anything, we men. As human speech had been associated with the © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC are particularly reliant on the written records handed rational part of the soul since Pythagoras (2580–2428 NOT FORdown SALE to us fromOR DISTRIBUTIONthe past, and writing did not develop NOTBP), FOR this was SALE an important OR DISTRIBUTION step for the examination of until 5,500 years BP in the Middle East; even then, the relationship among speech, language, and brain. writing was limited to very few experts. But the brain Plato’s pupil Aristotle (2384–2322 BP) had a par- had no great importance in ancient Egyptian medi- ticularly significant impact in subsequent centuries cine and religion. For instance,© Jones in mummification,& Bartlett Learning, all on LLC philosophy and the development© Jones of medicine. & Bartlett He Learning, LLC the organs were stored,NOT but the FOR brain SALE was pulled OR DISTRIBUTION out defined humans as speakingNOT animals FOR and SALE language OR DISTRIBUTION through the nose with a hook and discarded. This is as innate, with the variety of languages in the world a reflection of the cardiocentric view, where the heart coming about through social factors. In contrast to his was seen as the home of the soul, wherein resided a teacher Plato, he argued that the heart was the home capacity© forJones good and& Bartlett evil. Learning, LLC of all cognitive,© Jonesperceptual, & Bartlett and associated Learning, functions. LLC TheNOT oldest FOR known SALE reference OR DISTRIBUTIONto what we now call NOT FOR SALE OR DISTRIBUTION aphasia is in the Edwin Smith Papyrus (5000–4200 Ventricular Theory BP), a medical record of a number of cases of brain Over time, the brain began to figure in Greco- damage (Breasted, 1930). One record refers to a man Roman thought. Herophilos (2335–2280 BP), who who is “speechless” and states that the speechless- is recognized as the “father of anatomy,” described © Jonesness & Bartlettis “an ailment Learning, not to beLLC treated” but that rub- © Jonesthe cortex, & Bartlett cerebellum, Learning, ventricles LLC of the brain, and NOT FORbing SALE ointment OR on DISTRIBUTION the head and pouring a fatty liquid NOTsensory FOR and SALE motor OR nerve DISTRIBUTION trunks. It was with him (possibly milk) into the ears is a beneficial therapy. that ventricular theory developed and where a

connection was made between the “psyche” (soul) fourth ventricle) and were conceptualized as memory © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC and the ventricles of the brain. Ventricular theory, or disorders. The idea that aphasia was a memory disor- NOT FOR SALEcell theory, OR DISTRIBUTION to give it its other name, dominated intoNOT FORder SALEwas to dominate OR DISTRIBUTION well into the 19th century. the middle ages. There are references to aphasia during this time. Galen (2130–2200 BP) was the most significant Antonio Guainerio (died 1440) suggested that the brain anatomist until the 17th century. Galen was cause of aphasia was damage to the fourth ventricle a physician to the© Jonesgladiators & Bartlettand so had Learning, extensive LLC(the third cell) and memory© Jones was &impaired Bartlett because Learning, LLC experience of woundsNOT FORto the SALE head ORand DISTRIBUTIONthe brain, the ventricle containedNOT too FORmuch SALEphlegm. OR Nicolò DISTRIBUTION although the dissection of human bodies was pro- Massa (1489–1569) described a man who lost his hibited by Rome. He dissected cows, monkeys, speech after sustaining a head wound in battle; Massa pigs, dogs, cats, rodents, and at least one elephant. thought that a bone splinter had been left in the brain. Although© Jones working & Bartlett in the Learning, tradition ofLLC Aristotle, he He located© Jones it and pulled& Bartlett it out, Learning, and immediately LLC the rejected Aristotle’s theory. NOT FOR SALE OR DISTRIBUTION patient NOTcalled FOR out SALE(apparently OR inDISTRIBUTION Latin!), “Ad Dei laudem, sum sanus!” (God be praised, I am healthy!). The Spaniard Francisco Arceo (1493–1573) described The Middle Ages a worker who was hit on the head by a stone and The Middle Ages run from the demise of the Roman was speechless for several days. Arceo remedied the © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Empire (400s) to the emergence of the Renaissance fracture, and, some days later, the patient began to NOT FOR SALE(1500s). OR During DISTRIBUTION the Middle Ages, cell theory develNOT- FORspeak SALE again OR and DISTRIBUTION apparently recovered fully through oped from ventricular theory (see Figure 2.1), but the spontaneous recovery. ventricles were understood as theoretical concepts, rather than as anatomical structures, and simply depicted as circles.© InJones this model, & Bartlett aphasic Learning, symptoms LLCThe Renaissance© Jones & to Bartlett the Learning, LLC appear to result NOTfrom damageFOR SALE to the ORthird DISTRIBUTION cell (the 17th CenturyNOT FOR SALE OR DISTRIBUTION The Renaissance (the “rebirth”) emerged and suc- ceeded the darkness of the Middle Ages. It began in ETRICVLVS Italy in the 15th century, spread throughout Europe, I.V II © Jones & IBartlett Learning, ILLC.V and is associated© Jones with& Bartlett the beginnings Learning, of modern LLC sci- NOT FORS SALE OR DISTRIBUTIONE NOT FOR SALE OR DISTRIBUTION V T ence and modern medicine. L R From the Renaissance to the 17th century, cen- V I

C C tral advances were made in anatomy and physiology

I V

R L of the brain, and increasing attempts were made to

T S connect behavioral and cognitive functions to specific

V structures of the brain. Descriptions of aphasic symp-

. NOT FOR SALE OR I DISTRIBUTION NOT FOR SALE OR DISTRIBUTION toms became more precise, and early hypotheses on the causes began to emerge. There were major advances in the development of medicine during the Renaissance, and a number of central personalities and their insights © Jones & Bartlett Learning, LLCin medicine and philosophy© Jones stand &out. Bartlett Leonardo Learning, da LLC NOT FOR SALE OR DISTRIBUTIONVinci (1472–1519) madeNOT significant FOR SALE contributions OR DISTRIBUTION to anatomy. Da Vinci, the exemplary Renaissance man, used empirical methods, including anatomical investigations on animal and human corpses, and produced © Jones & Bartlett Learning, LLC exact anatomical© Jones sketches & Bartlett far superior Learning, to those LLC of the NOT FOR SALE OR DISTRIBUTION earlier NOTmedieval FOR tradition. SALE For OR example, DISTRIBUTION he noted that there was only an imprecise connection between the medieval drawings of ventricles and his own, although he did not question the belief in ventricular theory. Two prominent Renaissance anatomists who dis- © Jones & BartlettFigure 2.1 Learning, The ventricles LLC of the brain according to © Jonesmissed & Bartlett Galenian Learning, ventricular LLC theory were Andreas medieval cell theory NOT FOR SALE OR DISTRIBUTION NOT FORVesalius SALE (1514–1564) OR DISTRIBUTION and Thomas Willis (1621–1675). Modified from Magnus, A. (1490).Philosophia pauperum, sive Philosophia naturalis [Poor philosophy or natural philosophy]. Georgius Arrivabenus. Vesalius published his famous book, On the fabric of the

human body, in 1543; the seventh and last volume is body and soul permitted the Church to lift its ban © Jones & Bartlett Learning, LLC © Jonesdedicated & Bartlett to the Learning, brain. This bookLLC was a major advance on anatomical sectioning, and so the basis for further NOT FORin anatomical SALE OR detail DISTRIBUTION and neurology and dismissed much NOTadvances FOR inSALE medicine OR inDISTRIBUTION the 18th and 19th centuries of Galenian anatomy. The ventricles are described in was established. detail, but memory is not localized there: It is in the cerebellum instead. Thomas Willis (1621–1675)© Jones &gained Bartlett his knowl Learning,- The LLC 18th Century© Jones & Bartlett Learning, LLC edge of the brain fromNOT his observationsFOR SALE of OR patients DISTRIBUTION NOT FOR SALE OR DISTRIBUTION with neurological conditions and was of great impor- Enlightenment: Reason tance for the developing neuroscience of the 17th and Nature century. His great work, Cerebri Anatome (Anatomy Isaac Newton (1642–1727) supposed, based on of the Brain & Nerves, 1664/1965), benefits from the © Jones & Bartlett Learning, LLC Aristotle’s teachings,© Jones that & allBartlett human Learning,bodies contain LLC anatomical drawings of the young Christopher Wren, NOT FOR SALE OR DISTRIBUTION a hidden, vibratingNOT FOR“ether” SALE that moved OR DISTRIBUTION through the later to design St. Paul’s Cathedral and the center of nerves from sensory organs to brain and then to mus- London following the Great Fire of London. Willis cles and was under the command of the will. This dismissed ventricular theory, stating that mental life was Newton’s vibration theory. The philosopher John was essentially dependent on the cortex, thereby Locke (1632–1704) considered the human mind a © Jonespossibly & Bartlett advancing Learning, the first LLC cortical theory of the © Jones & Bartlett Learning, LLC collecting point for sensory perceptions that are pro- NOT FORcontrol SALE of musclesOR DISTRIBUTION and reflexes (Bennett & Hacker, NOT FOR SALE OR DISTRIBUTION cessed, connected, and associated with each other. 2003). He also suggested that the gyri, or convolu- David Hartley (1705–1757), most famous for his tions, of the brain are responsible for memory and discovery of the circulation of the blood around the will. He proposed a corporeal, or physical, soul pres- body, considered that the gyri were responsible for ent in humans and animals and associated it with vital © Jones & Bartlett Learning,memory LLC and the will and attempted© Jones to explain & Bartlett mem- Learning, LLC spirits, a kind of distilled liquor that was made in the NOT FOR SALE OR DISTRIBUTIONory through association of ideasNOT and FOR Newton’s SALE vibra OR- DISTRIBUTION brain and circulated in the blood. For Willis, the soul tion theory, which he combined in neurophysiology was immortal, nonmaterial, and separate from the to produce associationism. brain, with interaction between body and soul. The idea that aphasia was an impairment of During the Renaissance and the following centu- memory continued to dominate in the 17th and 18th ries, because© Jones man &was Bartlett thought Learning, to have been LLC created © Jones & Bartlett Learning, LLC centuries and indeed well into the 19th. For instance, in God’sNOT image, FOR anatomical SALE ORsectioning DISTRIBUTION of the human NOT FOR SALE OR DISTRIBUTION Johannes Jakob Wepfer (1620–1695) described at body continued to be prohibited by the Church. The least 13 clear cases of language disorder with brain body was not to be violated by the anatomist’s knife. injuries, which he attributed to memory loss. Johann A solution to this problem came from the philosopher Gesner (1738–1801) described his patient KD in the René Descartes (1596–1650) in the 17th century. © Jones & Bartlett Learning, LLC © Jonesbook The & Language Bartlett Amnesia, Learning, where LLC he laid the foun- Each age has its dominant technology—for us in NOT FOR SALE OR DISTRIBUTION NOTdation FOR for SALE the first OR real DISTRIBUTION theory of aphasia, an impair- the latter part of the 20th and early 21st centuries, it is ment of memory caused by a congestion of the “nerve computer technology—and we tend to use the com- ducts,” and, according to Benton (1965), his was the puter metaphor to explain the workings of the mind. first associationist aphasia theory. Gesner separated Mechanics and hydraulics were the most highly language from speech programming and laid the developed technologies© inJones the 17th& Bartlett century, Learning, and LLC © Jones & Bartlett Learning, LLC foundations for a separation of communicative com- Descartes described humansNOT FORas machines, SALE ORmechan DISTRIBUTION- NOT FOR SALE OR DISTRIBUTION petence, the latter apparently unimpaired in KD. ical automatons, in his work De Homine (On Man). However, this automaton was a true human because it possessed a divine soul, and, when the body died, The 19th Century and the soul© livedJones on. &The Bartlett difficult Learning, question remained LLC as © Jones & Bartlett Learning, LLC to whereNOT the FORsoul hadSALE its home, OR DISTRIBUTION and Descartes sug- the BirthNOT FORof aSALE Science OR DISTRIBUTION gested that it was in the pineal gland, a gland the size of a pea and lying at the base of the brain but, cru- of Aphasiology cially (for neuroanatomists at the time), just outside There was probably no real “science” of aphasiology the brain proper. For Descartes, the unity between until Gesner’s work but not until the 19th century © Jonessoul & Bartlettand body Learning,was only possible LLC in humans, a posi- © Jonesdid the &serious Bartlett systematic Learning, study LLC of aphasia begin. NOT FORtion SALE called ORCartesian DISTRIBUTION dualism, which is still influen- NOTThe FOR 19th SALEcentury OR is consideredDISTRIBUTION to be the founda- tial in current thought. This Cartesian separation of tion period of the modern history of aphasia mainly

because connections were made between the symp- With Gall, the foundations of cerebral localiza- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC toms of aphasia and the localization of areas of brain tion of function began as a serious idea. He was a NOT FOR SALE OR DISTRIBUTION NOT FOR SALEdamage, OR which DISTRIBUTION emerged to form the basis for the particularly skilled anatomist; he was also the first to later investigations of Broca, Wernicke, and others. recognize the importance of the neocortex in localiza- Napoleon’s reign in France dominated the begin- tion and described mental faculties (or “organs”) that ning of the 19th century in Europe. At that time, the were localized in specific parts of the brain. While Gall scientific climate© wasJones notably & Bartlettmore liberal Learning, in France LLCattributed no specific functions© Jones to & the Bartlett separate Learning,hemi- LLC than in the rest ofNOT Europe. FOR This SALE was oneOR reason DISTRIBUTION that spheres of the brain, heNOT did claim FOR that SALE the faculty OR DISTRIBUTION for Franz Josef Gall (1764–1828), a brilliant and highly words, which was part of the faculty for language, was significant anatomist, left Austria for France. His located in the frontal lobe, although this insight was organology (better known as phrenology, the term tenuously based on an observation Gall had made of coined© Jones by his& Bartlettstudent Spurzheim)Learning, hadLLC a massive a verbally© Jonesgifted school & Bartlett friend who Learning, could learn LLC verbal influence on ideas about aphasia, neuroanatomy, NOT FOR SALE OR DISTRIBUTION materialNOT very well.FOR His SALE friend OR had DISTRIBUTION strongly protruding and neuropsychology, even to the present day (see eyes, suggesting to Gall that the boy’s brain was partic- Figure 2.2). Organology considered that the inner ularly well developed behind the eyes, causing them form of the cranium was determined by the external to protrude; this suggested a large language organ form of the brain and it was therefore possible to situated in the frontal lobes. For Gall, the faculty of © Jones & Bartlettdetect the Learning, strength of LLC particular human “faculties”© Jones & Bartlett Learning, LLC language was innate, independent, and autonomous NOT FOR SALEfrom ORthe shape DISTRIBUTION and size of the cranium. He wrote:NOT FOR SALE OR DISTRIBUTION of reason and intelligence, and its primary purpose The possibility of a theory of the psycholog- was as a means of expression. More recently, this has ical and mental functions of the brain pre- formed the basis for the idea that cognitive functions supposes: . . . that the brain was the organ of are organized into modules, an important feature of all tendencies,© allJones emotions & Bartlett and all facultiesLearning, LLCmodern cognitive neuropsychology.© Jones & Bartlett Learning, LLC . . . [and] thatNOT the brainFOR was SALE composed OR DISTRIBUTION of as The most importantNOT follower FOR of SALEGall in ParisOR DISTRIBUTIONwas many individual organs as there are tenden- Jean Baptiste Bouillaud (1796–1881), a founding cies, emotions, faculties, which essentially dif- member of the French Société Phrénologique who was fer from one another. (Lesky, 1979 as cited in critical of most of the fanciful claims of phrenology © JonesTesak & & Code, Bartlett 2008) Learning, LLC in general© Jones but was & aBartlett passionate Learning, supporter LLCof Gall’s NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Veneration Firmness Agreeableness Conscienti- Self-esteem Hope Benevolence ousness Approbative- Imitation ness Human nature Spirituality

Conti- © Jones & Bartlett Learning, LLC © JonesSublimity & Bartlett Learning,nuity LLC NOT FOR SALE OR DISTRIBUTIONEventuality NOTIdeality FOR SALECautiousness OR DISTRIBUTION ComparisonCausality Mirth Locality Acquisitive-

Secretiveness eness ness Time Construc- Individuality Weight Tune

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Inhabitiv

Adhesiveness Friendship or Friendship Size Order Destructiveness Form Calculation © Jones & Bartlett Learning, LLCAlimentive- © Jones & Bartlett Learning, LLC ness NOT FOR SALE ORLanguage DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Combativeness Parental love

Conjugality Vitality and cells Amativeness © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEFigure OR 2.2 DISTRIBUTIONThe 37 faculties, or phrenological organs,NOT according FOR to SALEJohann KasparOR DISTRIBUTION Spurzheim Modified from O’Dell, E., & O’Dell, G. (1899).Phrenology: Essays and studies. London Phrenological Institution.

language localization theory. He published studies was already very ill, and his demise was imminent. © Jones & Bartlett Learning, LLC © Jonesuntil & Bartlettthe 1840s, Learning, describing moreLLC than 500 cases that Auburtin announced that he would publicly revoke NOT FORhe claimedSALE ORsupported DISTRIBUTION his view that language and NOThis viewsFOR onSALE localization OR DISTRIBUTION if Bache’s brain (or that of any speech were localized in the frontal lobes. He iden- other speech/language-disordered patient) displayed tified the connection between the separate loss of no frontal brain damage in a postmortem autopsy. It language and speech and frontal brain damage in sig- was this public announcement by Aubertin that trig- nificant numbers of patients© Jones he described & Bartlett and dividedLearning, gered LLC the interest of Pierre-Paul© Jones Broca (1824–1880), & Bartlett Learning, LLC the disorders, into articulationNOT FOR disorders SALE (whatOR DISTRIBUTION we and Auburtin’s contribution hasNOT been FOR overshadowed SALE OR DISTRIBUTION would now call apraxia of speech) and language dis- by the colleague he inspired. Anthropology played orders due to a memory problem. In the first, words an essential role in the debates on localization at this are no longer correctly organized or retrievable or time, and it was not a coincidence that questions of usable,© and, Jones in the & other,Bartlett the Learning,memory form LLC of the language localization© Jones were & Bartlett under discussion Learning, in theLLC word itselfNOT is FORdamaged. SALE But ORphrenology DISTRIBUTION was scorned AnthropologicalNOT Society FOR in SALE Paris in OR the DISTRIBUTION1860s (Broca, by most scientists at this time, and Bouillaud had few whose primary interest was anthropology, was supporters. In opposition to the localizationists, like cofounder and secretary). By coincidence, on April 12, Bouillaud, were the holists, most prominent being a patient named Leborgne was transferred to the Pierre Flourens (1794–1867) (Finger, 1994), who clinic of Bicêtre Hospital, where Broca was working. © Jonescarried & Bartlett out brain Learning, ablation LLCand stimulation experi- © JonesAuburtin & accompaniedBartlett Learning, Broca, who LLC had little expe- NOT FORments SALE that wouldOR DISTRIBUTION be considered primitive by today’s NOTrience FOR of aphasiaSALE ORat that DISTRIBUTION time, in an examination of standards. He used “spoons” for ablations and often Broca’s patient. The 51-year-old man had epilepsy removed large parts of the brain such that the behav- since his youth, loss of speech 21 years earlier, and ioral losses following ablations were often similar. In paralyses of the right arm for 10 years and of the leg his stimulation studies,© he Jones observed & thatBartlett irritation Learning, of for LLC 4 years. Leborgne’s comprehension© Jones was & Bartlettsaid to be Learning, LLC the cortex produced noNOT reaction FOR at all.SALE He concluded OR DISTRIBUTION intact, but for Broca comprehensionNOT FOR was notSALE part OR of DISTRIBUTION that the cortex is not divided into functional regions language per se but of intelligence and memory. He but that functions are represented throughout the had almost no speech apart from the speech automa- brain, what we now call cortical equipotentiality. tisms tan tan (nonlexical) and sacré nom de dieu (lex- Bouillaud and other localizationists had difficulties ical). Following Leborgne’s death on April 17 and getting© their Jones views & accepted Bartlett by Learning,the scientific LLC commu- brain autopsy,© Broca Jones described & Bartlett Leborgne Learning, the next dayLLC nity. FromNOT Flourens’s FOR SALE first ORpublications DISTRIBUTION in the 1820s (April 18) at NOTa meeting FOR of SALE the Anthropology OR DISTRIBUTION Society until the 1870s, equipotentiality was the dominating (Broca, 1861). Leborgne had a massive frontal lesion paradigm of brain physiology. However, the dispute centered on the third frontal gyrus (see Figure 2.3), between the localizers and the equipotentialists was and Broca called Leborgne’s disorder aphemia, mean- © Jonesnot & restrictedBartlett toLearning, the question LLC of localization in the © Jonesing loss &of Bartlett articulate Learning, speech, a term LLC that is still in NOT FORbrain. SALE First, OR it was DISTRIBUTION a question of what was the right NOTuse, FOR although SALE now OR mainly DISTRIBUTION called apraxia of speech. methodology: the clinical observation/case studies With this, modern aphasiology and neuropsychology of the localizers or the repeatable experiments (e.g., were born, and Broca proclaimed that the third fron- animal brain ablations), the approach of Flourens’s tal convolution was the seat for articulated language. followers. In addition, the two groups took different Broca’s description of Leborgne is still regarded as basic political and philosophical© Jones positions & Bartlett that Learning,influ- the LLC most significant event in© the Jones modern & Bartletthistory of Learning, LLC enced the neurologicalNOT debate. FOR Following SALE theOR revo DISTRIBUTION- aphasia and was taken by mostNOT as confirmationFOR SALE thatOR DISTRIBUTION lution of 1848 in France instigated by Napoleon III, the views of Bouillaud, Gall, and Auburtin were cor- the localizationists took the role of progressive liber- rect: that language and speech processing was indeed als and the equipotentialists the role of conservatives. localized in this specific area of the brain. We have Bouillaud’s© Jones son-in-law, & Bartlett Ernest Auburtin Learning, (1825–1893), LLC learned more© aboutJones Leborgne & Bartlett the personLearning, recently, LLC was a NOTsignificant FOR SALEfigure ORin the DISTRIBUTION Paris Anthropology thanks to DomanskiNOT FOR (2013). SALE We OR now DISTRIBUTION know that Society and the Paris language localization debates of Louis Victor Leborgne was born in 1809 in Moret, 1861–1866. He argued strongly for the localization France. His father was Pierre Christophe Leborgne, a of speech to the frontal lobes. teacher, who married Margueritte Savard, the daugh- On April 4, 1861, Auburtin presented a patient, ter of a guardsman, in 1801. They had six children, © JonesBache, & Bartlett who had Learning, lost his speech LLC but was left with the © Jonesincluding & LouisBartlett Victor. Learning, The family LLC was educated and NOT FORautomatism SALE OR “sacré DISTRIBUTION nom de dieu” and was said to NOTliterate; FOR one SALE of his OR nephews DISTRIBUTION became an official in one understand everything and to be of sound mind. He of the ministries. The received opinion that Leborgne

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Figure 2.3 The brain of Leborgne (tan tan), the famous case presented by Broca in 1861 Courtesy of La Semaine Medicale.

was an uneducated© Jones illiterate & fromBartlett the lowerLearning, social LLCunknown country doctor© Joneshad already & Bartlett made the Learning, con- LLC orders is clearly NOTfalse, andFOR we SALE know ORthat DISTRIBUTIONeducation nection between left-hemisphereNOT FOR damage SALE and OR speech DISTRIBUTION and illiteracy are relevant to aphasia. He worked until and language impairment in 1836. Marc Dax (1770– he was 30 as a formier—a craftsman who produced 1837) had already written a paper for a regional phy- forms for shoemakers. sicians’ meeting in 1836, one year before his death Broca presented further cases of aphemia in 1863 but nearly 30 years before Broca’s paper wherein (Broca,© Jones 1863), & Bartlettall of whom Learning, had damage LLC to the left the connection© Jones between& Bartlett left-hemisphere Learning, LLC lesions hemisphere,NOT FOR andSALE for all,OR except DISTRIBUTION one, the damage was and speechNOT FORdisorders SALE was OR clearly DISTRIBUTION stated: “There to the third frontal gyrus. While he noted that it was now remains a very interesting problem to solve: strange that all the lesions were in the left hemisphere, why does it happen that changes to the left cere- he made no issue of the fact. The beginning of the bral hemisphere are followed by the loss of words, © Jones & Bartlettidea that Learning,the left hemisphere LLC was dominant for speech© Jones but & notBartlett those ofLearning, the right hemisphere?” LLC (Dax, 1865, NOT FOR SALEand language OR DISTRIBUTION and for most other useful functions NOTwas FORp. 260). SALE But OR Marc DISTRIBUTION Dax’s work remained unpublished, formally crystalized in 1865 when Broca finally for- and there is little evidence that he actually delivered mulated a theory of language lateralization (Bogen, the paper at the regional meeting, although it was 1969)—that is, that language was represented in the submitted for publication to the Académie de Méde- left hemisphere. In 1865, he wrote his famous sen- cine by his son, Gustave Dax, together with his own tence, “We speak© with Jones the left& Bartlett hemisphere” Learning, (“’Nous LLCcontribution, as early ©as Jones1863, still & Bartlett2 years before Learning, LLC parlons avec l’hémisphèreNOT FOR gauche”) SALE OR(Broca, DISTRIBUTION 1865, Broca’s 1865 paper. ButNOT the FORDax contribution SALE OR DISTRIBUTIONwas p. 384). He also discussed right-hemisphere compen- not published until 1865, when Broca also argued sation in the case of damage to the left (Broca, 1865, in favor of left lateralization. This led to a bitter con- p. 384) and that people with aphemia could actually flict, withGustave Dax claiming that his father was be© Jonestreated under & Bartlett therapeutic Learning, guidance LLC following the the first© Jonesto discover & Bartlett the role Learning,of the left hemisphere LLC principlesNOT FOR of SALEchild language OR DISTRIBUTION acquisition. These ideas in the controlNOT FOR of speech SALE production OR DISTRIBUTION (Schiller, 1992). appear to be the first to propose the possibility of Dax’s paper was discussed widely among the aphasi- reorganization of the brain and language following ologists of Paris and its merits judged by a committee damage (Code, 1987). of the Academy led by Broca’s colleague Bouillaud. However, the position of Broca as the originator They took months to come to a decision, and it is © Jones & Bartlettof the idea Learning, of left-hemisphere LLC dominance remains© Jones suspected & Bartlett that Learning,this delay was LLC to give Broca time to NOT FOR SALEcontroversial OR DISTRIBUTION (Finger & Roe, 1996; Joynt & Benton,NOT FORfinish SALE and ORpublish DISTRIBUTION his own paper (Tesak & Code, 1964; Schiller, 1992), with many contending that an 2008). So perhaps Marc Dax is the one who should

be credited with the original finding that language components to underlie the basic operations and © Jones & Bartlett Learning, LLC © Jonesis &lateralized Bartlett to Learning, the left, but LLC he was just a country pathways involved in the production and reception NOT FORdoctor SALE and BrocaOR DISTRIBUTION was already famous. NOTof speech,FOR SALE at least OR at the DISTRIBUTION single-word level, from the Despite Broca’s fame and influence, his preferred highest cognitive center to the peripheral input and term for the disorder he had described, aphemia, was output levels. The model included a sound-image replaced with the term aphasia mainly because of system and fiber connections, explained patholo- an article in 1864 by ©prominent Jones &physician Bartlett Armand Learning, gies LLC of speech and language, ©and Jones predicted & Bartlett forms of Learning, LLC Trousseau (1801–1867)NOT with FOR the SALEprovocative OR DISTRIBUTIONtitle aphasia that had not yet beenNOT discovered. FOR SALE In 1885, OR DISTRIBUTION On aphasia, a sickness formerly wrongly referred to as Lichtheim took Wernicke’s model and expanded aphemia. He pointed out that the term aphasia from and refined it to produce what we now know as the the Greek meaning “without language,” was more Wernicke–Lichtheim model (Figure 2.4), which was appropriate© Jones than &aphemia Bartlett (without Learning, speech). LLC Trous- to dominate aphasia© Jones theory & Bartlett in most of Learning, the world well LLC seau believed that aphasia was a cognitive disorder into the 20th century. Because of its obvious similar- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION that affected intellectual performance, a view also later ity to the outline of a house, it is sometimes called the expressed by John Hughlings Jackson. Of course, Bro- Wernicke–Lichtheim House. ca’s term referred to speech, as it still does today, and However, not everyone was seduced by the local- Trouseau’s to language. izationist agenda. During the 1874 Berlin language © Jones & HenryBartlett Head Learning, (1926) noted LLC that much of the © Jonesdebate, the& Bartlettlocalizationist Learning, Hitzig took LLC an opposing view NOT FORgreat SALE growth OR in DISTRIBUTIONGerman neurology and dominance NOTto that FOR of Steinthal,SALE OR who DISTRIBUTION was probably the first real psy- in aphasiology was related to German victory in cholinguist (Eling, 2006). Heymann (Chajim) Steinthal the Franco-Prussian war of 1870–1871. It was (1871) complained that the physicians’ descriptions of in this climate that universities in Germany and language and aphasia were too superficial and lacked German-speaking countries© Jones became & Bartlettthe world Learning, lead- the LLC necessary linguistic detail,© aJones complaint & Bartlett that still Learning, LLC ers for scientific research.NOT A FORlandmark SALE development OR DISTRIBUTION resonates. Steinthal stated, exasperatedly,NOT FOR “The SALE clinical OR DISTRIBUTION in neurology was fiber theory developed byTheodor pictures have been recorded by far too incompletely von Meynert (1833–1892) in Vienna (Whitaker & and imprecisely; our physicians have not understood Etlinger, 1993). Fiber theory described the import- what the function of language is” (1871, p. 464). In ant distinction between projection fibers, which England, John Hughlings Jackson (1835–1911) was connect© subcorticalJones & Bartlettto cortical Learning, regions, and LLC asso- also opposed ©to Joneslocalization & Bartlett and proposed Learning, that reorga LLC- ciationNOT fibers, FOR which SALE connect OR DISTRIBUTIONcortical areas to one nization of functionNOT couldFOR takeSALE place OR following DISTRIBUTION damage. another. Thus, projection fibers communicate sen- Jackson was more than simply an antilocalizationist, sory information from the sensory organs to the however. Darwin’s On the Origin of Species was published cortex, and the association tracts transmit percep- in 1859, and the colossal impact that his evolutionary © Jonestions, & Bartlett ideas, and Learning, memory LLCcontents between areas. © Jonestheory had & Bartlett on both Learning,scientific and LLC public opinion is Von Meynert was also responsible for determining legendary. Subsequently, Jackson developed his highly NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION that the anterior part of the brain was responsible significant theory of the evolution and organization of for motor function and the posterior part for sen- the nervous system, informed by his observations of sory function. His work with patients with apha- aphasia and epilepsy and extensively influenced by the sia led him to describe a “sound image system.” evolutionary ideas of Herbert Spencer (1820–1903). This, and other aspects© ofJones fiber &theory, Bartlett form Learning, parts Head LLC (1926) noted that “Jackson© Jones derived & all Bartlett his psy- Learning, LLC of the theory developedNOT by FOR von SALE Meynert’s OR DISTRIBUTIONstu- chological knowledge from NOTHerbert FOR Spencer, SALE and OR DISTRIBUTION dent Wernicke. In 1874, the young physician Carl adopted his phraseology almost completely (p. 31). Wernicke (1848–1905) completed his thesis, The But his work on aphasia had little impact outside Brit- Symptom-Complex of Aphasia, where in he described ain and remained relatively unrecognized until Head’s cases with© Jones sensory & aphasia Bartlett due Learning, to lesions in LLC the pos- writings led to© Jonesits recognition & Bartlett in the Learning,early 20th cen LLC- terior NOTleft brain. FOR With SALE Broca’s OR DISTRIBUTIONanterior production tury. Jackson NOThad observed FOR SALE that peopleOR DISTRIBUTION with aphasia aphasia (aphemia) and Wernicke’s posterior sensory can often produce complete phrases in particular con- aphasia, the basis for a fuller theory of language texts (e.g., curses, exclamations, and stereotypies), even processing was developed. However, the impact of when they possessed little or no spontaneous speech, Wernicke’s thesis went well beyond describing “sen- and he acknowledged Baillarger’s (1865) earlier distinc- © Jonessory” & Bartlett aphasia, Learning,which had already LLC been described by © Jonestion between & Bartlett voluntary Learning, and involuntary LLC speech. Jackson NOT FORBastian SALE (Tesak OR &DISTRIBUTION Code, 2008). Wernicke devised NOT(1878–1880, FOR SALE as cited OR DISTRIBUTIONin Taylor, 1958) hypothesized what today we would call information processing that both the ontogenic (individual development)

6 4 1 2 M A © Jones & Bartlett3 Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE5 OR DISTRIBUTION7 NOT FOR SALE OR DISTRIBUTION

m a © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC B O NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

M © Jones & Bartlett Learning, LLC © Jones & BartlettA Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

E © Jones & Bartlettm Learning, LLC a © Jones & Bartlett Learning, LLC NOT FORA: Acoustic SALE center OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION M: Motor center B: Concept center O: Optical memory images for letters E: Region from which writing movements are innervated m: Motor pathway © Jones & Bartlett Learning,a: Acoustic path LLCway © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Figure 2.4 The Wernicke–Lichtheim model of language processing Modified from Lichtheim, L. (1885). Ueber Aphasie: Aus der medicinischen Klinik in Bern [About aphasia: From the medical clinic in Bern].Deutsches Archiv fur Klinische Medizin, 36, 204–268.

© Jones & Bartlettand phylogenic Learning, (species LLC development over time) evo© Jones- lower & Bartlett levels released Learning, from inhibition LLC of higher levels lution of the nervous system entailed the following: caused by brain damage. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION (1) a course from the most to the least organized, from Many aphasiologists at this time were very the lowest, well-organized centers to the highest, least interested in clinical management and treatment of organized, centers; (2) a course from the most simple aphasia—Broca and Henry Charles Bastian (1837– to the most complex; and (3) a course from the most 1915), for instance. Bastian (1898) and Henry Head automatic to the ©most Jones voluntary. & Bartlett Dissolution Learning, is a term LLCdeveloped tests for aphasia,© Jones which & wereBartlett used Learning, well LLC he acquired from NOTSpencer FOR and SALE Jackson’s OR model DISTRIBUTION of the into the second half of theNOT 20th FOR century. SALE OR DISTRIBUTION nervous system, and it mirrors Spencer’s closely. Dis- The French suffered a military defeat at the hands solution of the nervous system, with a loss of function, of the Germans in 1870–1871, which resulted in the provides the inhibition of higher levels caused by brain Germans marching into Paris. As a result, the French damage,© Jones which & Bartlett Jackson saw Learning, as evidence LLC of the reverse scientific© Jonescommunity & Bartlett became closedLearning, to developments LLC ofNOT evolution. FOR FunctionsSALE OR are DISTRIBUTION organized hierarchically in in GermanNOT science FOR andSALE the revolutionOR DISTRIBUTION taking place in the nervous system based on Jackson’s theory at dif- German aphasiology. French aphasiology remained ferent levels of representation, from the oldest to the staunchly devoted to Broca’s mid-1860s findings (Gel- most recently developed in evolution and individual fand, 1999). Jean-Martin Charcot (1825–1893) was development, from the lowest to the highest, and from a leading neurologist in Paris and holder of the chair © Jones & Bartlettthe most Learning,primitive to the LLC most complex. Symptoms,© for Jones for & nervous Bartlett diseases Learning, at the HospiceLLC de la Salpêtrière. NOT FOR SALEinstance, OR aphasic DISTRIBUTION recurrent utterances (speech automNOT- FORHe SALEwas an ORadvocate DISTRIBUTION of a reactively patriotic compe- atisms), like Leborgne’s tan tan, are the expression of tition with German science, and, because of him and

his students, aphasia once again became an important writing, speaking, and reading, and the centers were © Jones & Bartlett Learning, LLC © Jonestopic & Bartlett in Paris, despiteLearning, the fact LLC that there was a signif- linked to one another through many connections. NOT FORicant SALE lack of OR enthusiasm DISTRIBUTION for advances outside France NOT FORHe attempted SALE OR to localizeDISTRIBUTION aphasic disorders and since Broca. Charcot was interested in localization went along with Broca’s finding that aphemia was throughout his career, although a small, but import- caused by a lesion of the third frontal gyrus, with ant, part of his work was with aphasia. In a series of a lesion in the second frontal gyrus as the cause of lectures (in 1883 and 1884),© Jones On the & Bartlettdifferent forms Learning, of agraphia. LLC Word deafness was caused© Jones by a &lesion Bartlett in the Learning, LLC aphasia (Charcot, 1884),NOT he FORdeveloped SALE his OR famous DISTRIBUTION first temporal gyrus and wordNOT blindness FOR from SALE a lesion OR DISTRIBUTION bell diagram (Figure 2.5), which was meant to allow to the lower parietal gyrus. a better understanding of normal and pathological Charcot’s diagram became well known through language processing. His model contained four cen- the work of the young Pierre Marie (1853–1940), ters for© memory Jones images& Bartlett (speech, Learning, language, LLC writing, who joined Charcot© Jones at the& Bartlett Salpêtrière Learning, in 1885 and LLC and reading) attributed to an association center. These became one of his most famous students. With the NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION centers were linked to the outside world by auditory work of the eminent Charcot, aphasia again became a and visual routes. Charcot, in common with many of topic of intense discussion in Paris. his predecessors, thus saw aphasia as a memory dis- In England, Hughlings Jackson published more order, with memory divided into subsystems; he also on his evolutionary approach to aphasiology and was © Jonesbelieved & Bartlett in submemories Learning, for LLClanguage, understanding, © Joneshardly influenced & Bartlett by Learning,the localization LLC debates going on NOT FOR SALE OR DISTRIBUTION NOTin GermanyFOR SALE and France, OR DISTRIBUTION although, as an editor of the

CACCVC new journal Brain, he published Lichtheim’s work in English in 1885. Bateman’s work, On Aphasia, or Loss 2 of Speech, appeared in 1890 in its second edition, in © Jones & Bartlett Learning,which LLC Charcot, Kussmaul, and© othersJones were & Bartlettincluded, Learning, LLC CAM CVM NOT FOR SALE OR DISTRIBUTIONalthough Bateman was opposedNOT to classificationsFOR SALE ORand DISTRIBUTION localization. At the end of the 1800s, Bastian (1898), in England, summarized his 30 years of work on aphasia. Another important critic of connectionism and 1 CLA CLE the Wernicke–Lichtheim model was Sigmund Freud © Jones & Bartlett Learning, LLC (1891/1953) ©in JonesVienna, &a Bartlettneurologist Learning, and aphasiol LLC- NOT FOR SALE OR DISTRIBUTION ogist before heNOT founded FOR psychoanalysis, SALE OR DISTRIBUTION who spent a Cloche Cloche few months with Charcot in 1885. He published his monograph on aphasia in 1891, but it was to have little impact at the time. However, it was published in © Jones & Bartlett Learning, LLC © Jonesan English & Bartletttranslation Learning, in 1953, and LLC more recently his contributions to aphasiology have been better appre- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ciated (Buckingham, 2006). Henry Head (1926) was famously opposed to the proliferation of diagram- matic models of the representation of language in the brain and launched a bitter assault on what he called © Jones & Bartlett Learning,“the LLC diagram makers.” © Jones & Bartlett Learning, LLC Cloche ‘Bell’ IC centre d’idéation NOT FOR SALE OR DISTRIBUTIONThe Swiss Jules Joseph NOTDejerine FOR (1849–1917) SALE OR DISTRIBUTION Association center was Charcot’s student and working in Paris, where he CAC centre auditif commun eventually became professeur de clinique des mala- General auditory center CAM centre auditif des mots dies du système nerveux in 1910. Dejerine described Hearing© Jonescenter for word& Bartletts Learning, LLC a classification© Jonessystem of& aphasia, Bartlett but Learning, mainly through LLC CLA centre de language articulé two case descriptions of isolated writing and read- CenterNOT for articulated FOR SALE speech OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CVC centre visuel commun ing disorders his work became important. Dejerine General visual center (1891, 1892) described a 63-year-old man with word CVM centre visuel des mots Visual center for words blindness (alexia) and total agraphia and a 61-year- CLE centre du langage écrit old educated woman with word blindness without © Jones &Center Bartlett for writing Learning, LLC © Jonesagraphia & who Bartlett could Learning, write spontaneously LLC and to NOT FORFigure SALE 2.5 Charcot’sOR DISTRIBUTION “bell” model NOTdictation FOR SALEand had OR no DISTRIBUTIONdifficulties withspontaneous Modified from Bernard, D. (1889).De l’aphasie et de ses diverses forms [Aphasia and its various forms]. Lecrosnier & Babe. speaking (Hanley & Kay, 2003). Autopsies showed

a lesion in the angular gyrus on the left for the first Pierre Marie followed Dejerine as professor of © Jones & Bartlett Learning, LLC © Jones & Bartlettcase and aLearning, lesion in the LLC area that separates the general neurology at the University of Paris and was one of NOT FOR SALElanguage OR areaDISTRIBUTION from the angular gyrus in the secondNOT FORthe SALEmost provocative OR DISTRIBUTION figures in the history of aphasia. case (Dejerine, 1892). He suspected that visual word Head (1926) called him “the iconoclast.” Marie was images are stored in the angular gyrus, which he originally a localizationist, like his mentor Charcot, assumed is necessary for reading and writing. Thus, but in 1906 he published a paper with the title alexia and agraphia© Joneswould result & Bartlett from a lesionLearning, to the LLC“Révision de la question© Jonessur l’aphasie: & Bartlett La troisième Learning, LLC angular gyrus. NOT FOR SALE OR DISTRIBUTIONcirconvolution frontale gaucheNOT FOR ne joue SALE aucun OR rôle DISTRIBUTIONspé- Three years later, he described yet another form of cial dans la fonction du langage” (“Revision of the ques- alexia as it commonly occurs in motor aphasia. This tion of aphasia: The third left frontal convolution plays “third alexia” is explained with reference to Dejerine’s no special role in the function of language”), which language© Jones zone, & Bartlett containing Learning, Broca’s area, LLC Wernicke’s vehemently© Jones attacked & BartlettBroca’s model Learning, of aphasia. LLC Marie area, and the angular gyrus, respectively responsible reported cases in which severe damage to this area did NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION for production, auditory comprehension, and writ- not result in aphasia and Broca’s aphasia could result ten language comprehension, and any disruption of without a lesion to the left third frontal convolution. the subcortical connecting pathways would lead to He also stated that “l’anarthrie n’est pas de l’aphasie” isolated phenomena. Cortical lesions of the language (“anarthria [Marie’s term for aphemia] is not aphasia”), © Jones & Bartlettzone led Learning,to a disorder LLC of “inner speech” and to disor© Jones- and & heBartlett coined Learning,the famous equation,LLC Broca’s aphasia NOT FOR SALEders suchOR asDISTRIBUTION alexia in motor aphasia. NOT FORequals SALE Wernicke’s OR DISTRIBUTION aphasia plus anarthria. Also active in France in the later 1800s, Albert Pitres (1848–1928) is well known for his early work on amnesic aphasia, his term for impaired naming, The Growth of Linguistic and his book on aphasia© Jones in bilingual & Bartlett and multilingualLearning, LLCAphasiology© Jonesin the & Bartlett 19th Learning, LLC speakers. The conceptNOT ofFOR amnesic SALE aphasia OR DISTRIBUTIONreceived a NOT FOR SALE OR DISTRIBUTION great deal of discussion from the 1860s, and Pitres and 20th Centuries attempted to establish it as an independent form of Attempts were made in the 19th and early 20th aphasia (Pitres, 1898). He described amnesic aphasia centuries to introduce linguistics as relevant in as “a form of aphasia in which the language difficulties aphasiology from Steinthal, Freud, and the phy- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC consist in having forgotten the words that are neces- sician Arnold Pick. On the basis of a more exact saryNOT to FORexpress SALE thoughts” OR (Pitres,DISTRIBUTION as cited in Benton, linguisticNOT examination, FOR SALE the OR early DISTRIBUTION psycholinguist 1988, p. 210), emphasizing that pure cases are rare. Steinthal (1871, p. 478) had described what he Amnesic aphasia would play an important role in called acataphasia, which he contrasted with apha- Geschwind’s reintroduction of the neoclassical model, sia. He suggested that the problem in aphasia was at © Jones & Bartlettdeveloped Learning, in the 1960s LLC in the United States, where© itJones the & lexical Bartlett level Learning, (a word memory LLC retrieval problem), would reemerge as what we now call anomic aphasia NOT FOR SALE OR DISTRIBUTION NOT FORwhereas SALE in ORacataphasia DISTRIBUTION it is at the sentence level: (Benton, 1988). an inability to make sentences, rather than poor Ribot (1881) had suggested that bilingual speak- memory for words. Forty years later, Arnold Pick ers with aphasia would recover their native language (1851–1924) took up the mantle with his work on first. This idea was in general support of his theory the development of agrammatism. Indeed, most of that recent memories© Jones are more& Bartlett vulnerable Learning, to loss LLCthis pioneering work came© Jones from &German-speaking Bartlett Learning, LLC than earlier onesNOT (Paradis, FOR 1981). SALE Pitres OR (as DISTRIBUTION cited in Europe. Pick (1913) tooNOT believed FOR that SALE the developOR DISTRIBUTION- Paradis, 1983, pp. 26–49) firmly believed that the ments in psychology and linguistics should form the most recently learned and familiar language is the one basis for a new theory of aphasia: that will recover first, and, unlike Ribot, he based his perspective© Jones &on Bartlett a detailed Learning, review of the LLC research and Not© onlyJones does & the Bartlett backwardness Learning, of the LLC still authoritative psychology for aphasia the- anNOT analysis FOR of SALE eight new OR cases. DISTRIBUTION Discussion continued NOT FOR SALE OR DISTRIBUTION for several years, with some supporting “Pitres’s rule” ory urgently demand a revision, it is also the that the most recently used and familiar language enormous progress that psychology itself has would recover first and some “Ribot’s rule” that the made. . . . [T]he situation in terms of linguis- first learned—the native language—would recover tic science presents itself similarly to that of © Jones & Bartlettfirst. Finally, Learning, Pitres strongly LLC opposed the idea that© dif Jones- &psychology Bartlett Learning, . . . of which LLC even the most recent NOT FOR SALEferent OR languages DISTRIBUTION could occupy separate locationsNOT in FOR SALEpresentations OR DISTRIBUTION of aphasia theory have not taken the brain. notice. (p. 9)

In modern terms, Pick was advocating, as Steinthal changes occurring in the words themselves, © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC had, a psycholinguistic perspective. In his mono- through conjugation, declination, and com- NOT FORgraph, SALE Agrammatic OR DISTRIBUTION Language Disorders: Studies on the NOT FORparison SALE (flexions OR inDISTRIBUTION the narrower sense), are Psychological Foundation of Aphasia Theory (1913), more or less omitted. (pp. 11–12) he developed a staged model of language production that shares many features with current models In contrast to this pattern, in paragrammatism: © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC (e.g., the contemporary models of Garrett [1980] and [T]he ability to create word orders is not Levelt [1989]). NOT FOR SALE OR DISTRIBUTIONabolished, but phrases NOTand sentences FOR SALE are OR DISTRIBUTION In Pick’s model, a mental schema develops that often wrongly chosen and thereby amal- includes pragmatic and emotional components, which gamate and contaminate each other . . . . today we would call an intention to communicate, or Phrases and sentence constructions are not a preverbal© Jones message. & Subsequently,Bartlett Learning, a sentence LLC schema completed© .Jones . . . The & Bartlettspoken expression Learning, is LLC is activated,NOT whichFOR SALEtakes place OR DISTRIBUTIONbefore word choice. not simplifiedNOT FOR overall; SALE instead, OR alsoDISTRIBUTION condi- The choice of a word, Pick stated, is determined only tioned by a strong over-production of word by the position it takes in the sentence, so it must sequences, it swells to confused sentence occur following sentence formulation. Likewise, word monsters. (p. 12) ordering and intonation precede word choice. Then, © Jonesgrammatical & Bartlett and Learning, lexical words LLC are built into the sen- © JonesKleist considered & Bartlett a mixed Learning, agrammatic- LLCparagrammatic NOT FORtence SALE schema; OR thus, DISTRIBUTION the specification of grammatical NOTsymptom FOR SALEpattern ORto be DISTRIBUTION the rule, and pure cases to be words (function words and inflections) precedes the rare. He was very clear with regard to the anatomical specification of content words. basis (Kleist, 1914, p. 12): “We will not go wrong Agrammatism for Pick was the core aphasic symp- if, contrary to frontal agrammatism, we localize para- tom, and he described separate© Jones forms & Bartlett associated Learning, with grammatism LLC in the temporal© lobe Jones or its & immediate Bartlett Learning, LLC impairments to the differentNOT FOR stages SALE of production. OR DISTRIBUTION neighbourhood.” NOT FOR SALE OR DISTRIBUTION To explain function word omissions in telegraphic Later, Kleist (1916, p. 170) modified his posi- speech, Pick supposed that the individual employs tion and concluded that the cause of agrammatism an economy of effort in the context of a severely was “a loss or lowering of excitability of sentence and impaired system—the word is omitted because it phrase formulae,” which approximately corresponds is the ©semantically Jones & leastBartlett useful Learning, in the sentence. LLC He to Pick’s sentence© Jones schemata, & Bartlett and in paragrammatism, Learning, LLC also discussedNOT FOR in detail SALE the OR idea DISTRIBUTION of “emergency lan- “sentence andNOT phrase FOR formulae SALE . . .OR are DISTRIBUTIONaroused incor- guage,” a form of adaptation of the system to brain rectly.” So, for Kleist (1916, p. 198), paragrammatism damage: “the whole mental language apparatus is caused “by an incorrect arousal of acoustic sentence accommodates itself . . . extraordinarily fast with formulae.” Kleist was another of Wernicke’s many © Jonesthe & situationBartlett created Learning, by the LLC illnesses” (Pick, 1913, © Jonesassistants, & andBartlett Wernicke Learning, had a significant LLC influence on him. Kleist was also an ultra-localizationist, and NOT FORp. 156) SALE. Similar OR DISTRIBUTIONviews would later also be developed NOT FOR SALE OR DISTRIBUTION by Isserlin (1922). his brain map went beyond even the phrenological In 1914, Karl Kleist (1878–1960) described an maps of Spurzheim in its detail. impairment he called paragrammatism, a second Russian linguist Roman Jakobson (1896–1980) word order disorder distinct from agrammatism. is sometimes considered the first to strongly apply Kleist stated: © Jones & Bartlett Learning,linguistics LLC in aphasiology, although,© Jones as noted & Bartlett above, Learning, LLC NOT FOR SALE OR DISTRIBUTIONSteinthal may be more worthy.NOT JakobsonFOR SALE was OR a DISTRIBUTION So far we have only spoken of agrammatism. founding member of the Linguistic Circle of Prague We retain the term agrammatism for one of established in 1926. When the Nazis entered Czecho- these two . . . word order disorders. The basic slovakia, Jakobson fled, first to Denmark, Norway, trait© ofJones agrammatism & Bartlett is the Learning,simplification LLC and and Sweden ©and Jones then to & the Bartlett United Learning,States in 1941, LLC coarseningNOT FOR of word SALE sequences. OR DISTRIBUTION Complicated where he eventuallyNOT FOR became SALE professor OR atDISTRIBUTION Harvard and compound sentences (subordination of clauses) the Massachusetts Institute of Technology. In his 1941 are not built. The patients only speak in small, monograph, Child Language, Aphasia, and Phonologi- primitive mini-sentences, if they continue cal Universals (English translation, 1968), Jakobson to create sentences at all. All less necessary describes parallels between language acquisition © Jones & words,Bartlett especially Learning, pronouns LLC and particles, © Jonesand aphasia & Bartlett and proposed Learning, a regression LLC hypothesis, NOT FOR SALEare reduced OR DISTRIBUTIONor eliminated . . . Conjugation NOTwhich FOR states SALE that weOR can DISTRIBUTION observe the same processes thereby also degenerates . . . But also the in both developing child speech and the impairments

of speakers with aphasia, but in reverse: “The dis- psychological model of a part of the mind and sub- © Jones & Bartlett Learning, LLC © Jones & Bartlettsolution Learning,of the linguistic LLC sound system in aphasics ject to scientific laws. Psycholinguistics advanced and NOT FOR SALEprovides OR an DISTRIBUTION exact mirror-image of the phonologicalNOT FORthe developmentSALE OR DISTRIBUTIONof experimental investigations of lan- development in child language” (Jakobson, 1968, guage processing grew, and these emerged as a dynamic p. 60), and “the order in which speech sounds are interchange on how the psychological reality of lin- restored in the aphasic during the process of recov- guistic constructs might be tested (see, for instance, ery corresponds directly© Jones to the& Bartlett development Learning, of child LLCMiller, 1964). A view was© alsoJones developing & Bartlett that aphasia Learning, LLC language” (p. 64).NOT FOR SALE OR DISTRIBUTIONcould be relevant for linguisticsNOT FOR and SALEpsycholinguistics OR DISTRIBUTION For Jakobson, there was no doubt that aphasia and vice versa. Linguistics has methods for describ- should be understood in terms of linguistic theories ing aphasic language and might provide details to and aphasia could test the validity of linguistic theo- inform treatment planning, and aphasic data can act as ries.© Jones Jakobson & (1964)Bartlett also Learning, attempted to LLC contrast Luria’s “external”© Jonesevidence & for Bartlett linguistic Learning, and psycholinguistic LLC six aphasia types (described below) in terms of three NOT FOR SALE OR DISTRIBUTION hypotheses.NOT The FOR separation SALE ORof abstract DISTRIBUTION phonological linguistic dichotomies: encoding (combination and and concrete phonetic components in speech produc- contiguity) impairments versus decoding (selection tion has been a theoretical position since the origins and similarity) impairments, limitation impairments of phonology and phonetics as disciplines, and doz- versus disintegration, and sequence (syntagmatic and ens of studies have demonstrated that the distinction © Jones & Bartlettsuccessivity) Learning, versus concurrence LLC (paragdigmatic ©and Jones accounts & Bartlett well forLearning, separate phonologicalLLC and apraxic NOT FOR SALEsimultaneity). OR DISTRIBUTION For instance, an encoding impairment,NOT FORspeech SALE errors OR occurring DISTRIBUTION in different people with apha- like Luria’s dynamic aphasia or efferent motor aphasia. A frequently observable double dissociation has sia, is characterized by problems with combination, been described between problems with referential, or whereas decoding impairments, like sensory or seman- modalizing, language that is differentially impaired tic aphasia, entail© impairments Jones & Bartlettin selection. Learning, Jakobson LLCacross the broad range of© aphasic Jones types. & Bartlett This evidence Learning, LLC is admired as a pioneerNOT FOR of linguistic SALE aphasiology, OR DISTRIBUTION but supports a model of languageNOT FORthat posits SALE a referential OR DISTRIBUTION his views had little mainstream impact and played little and a modalizing, form of language, which is taken part in contemporary linguistic aphasiology. to reflect certain linguistic and cognitive distinctions Not until the 1960s, when generative transfor- that cannot be accounted for by structurally motivated mational grammar emerged, did a broad linguistic linguistic models (Nespoulous et al., 1998). aphasiology© Jones &develop. Bartlett Chomsky’s Learning, ideas LLC were to have a Another© Jones theory & ofBartlett language Learning, that was to LLC become revolutionaryNOT FOR SALEimpact inOR linguistics, DISTRIBUTION cognitive psychol- relevantNOT in aphasiology FOR SALE from OR the DISTRIBUTION 1970s is systemic ogy, and philosophy. Noam Chomsky (born 1928) functional linguistics, developed by M. A. K. Halliday introduced transformational generative grammar (TG) (1961, 1985). At the heart of Halliday’s model is the at the turn of the 1950s and 1960s (Chomsky, recognition that language has a fundamental social © Jones & Bartlett1957b, 1965), Learning, and linguistic LLC science materialized ©as aJones function & Bartlett as well Learning, as a cognitive/referential LLC one. Language dynamic enterprise. Chomsky (1957a) famously wrote NOT FOR SALE OR DISTRIBUTION NOT FORcan SALEbe conversational OR DISTRIBUTION and used to develop, cement, a scathing critique of the behaviorist B. F. Skinner’s and maintain relationships using different registers book Verbal Behavior in which Skinner claimed that and styles, depending on whether the relationship is language development is accountable in terms of with a boss, loved ones, or friends and paralinguistic stimulus-response learning. Chomsky dismissed the features, such as facial expression, body language, and behaviorist account.© Jones For generative & Bartlett linguistics, Learning, chil- LLCgesture, are essential components© Jones &of Bartletteveryday Learning,com- LLC dren learn a set ofNOT rules FOR and haveSALE an ORinnate DISTRIBUTION capacity munication. Systemic linguisticsNOT FOR provided SALE methods OR DISTRIBUTION of for language acquisition; while learning is involved in analysis for all components of language and several language acquisition, they do not learn a set of utter- social contexts. This “functional” appreciation of lan- ances through imitation and reinforcement. guage has been fully incorporated into contemporary © JonesChomsky & proposedBartlett aLearning, partition between LLC linguistic psycholinguistic© Jones models & Bartlett (e.g., Tomasello, Learning, 2014). LLC competenceNOT FOR and SALE linguistic OR performanceDISTRIBUTION. Competence is NOT FOR SALE OR DISTRIBUTION the abstract system of mental representations and processes that constitutes the basis of language, and per- Aphasiology in the formance is the actual realization of language through 20th Century use. An important feature of TG is the powerful idea © Jones & Bartlettof a universal Learning, grammar LLC shared by all languages. © JonesThe & devastationBartlett Learning, of war brings LLC advances in science and NOT FOR SALEChomsky OR DISTRIBUTION regarded linguistics as a branchNOT of FORtechnology, SALE ORand aphasiaDISTRIBUTION and neuropsychology are no cognitive psychology. A theory of a language is a exceptions. The massive numbers of brain-injured

soldiers of World War I resulted in new approaches approach seemed to be altogether appropriate to © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC to rehabilitation, many pioneered by Kurt Goldstein understand the functioning of the human brain. NOT FOR(1878–1965), SALE OR who DISTRIBUTION is often considered the major NOTCentral FOR to SALE his approach OR DISTRIBUTION is the notion of a functional opponent to the classical localizationist approach system. Every single mental function (e.g., thinking, (Geschwind, 1965). He took a holistic view of apha- writing, and arithmetic) should be understood not as sia through his organismic approach and was deeply a single, simple function “but as a complete functional concerned with rehabilitation© Jones and & theBartlett psychosocial Learning, system, LLC embodying many components© Jones belonging& Bartlett to Learning, LLC impact of aphasia. WorldNOT War FOR I saw SALEthe development OR DISTRIBUTION different levels of . . . motor NOTand nervous FOR SALEapparatus” OR DISTRIBUTION of aphasia therapy from what Howard and Hatfield (Luria, 1973, p. 27). Therefore, “there can of course (1987) called the “speech gymnastics” of the Viennese be no question of the localization of complex func- phoniatricians Hermann Gutzmann (1865–1922), tional systems in limited areas of the brain or of its known© as Jones “the father & Bartlett of aphasia Learning, therapy,” andLLC Emil cortex” (Luria,© 1973, Jones p. 30).& Bartlett Learning, LLC Froeschels (1884–1973). They applied the techniques Mental activity is a complex functional system NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION they knew from voice therapy, articulatory drills, and “involving the participation of a group of concertedly primary school teaching techniques. In Britain, treat- working areas of the cortex” (Luria, 1973, p. 35). In ment of aphasia also was mainly developed by elocu- addition, functional systems are characterized by the tionists and voice teachers. Bastian was an exception variability and mobility of the participating mecha- © Jonesand & introducedBartlett Learning, the still-influential LLC division between © Jonesnisms. If & we Bartlett consider Learning, writing, for LLCinstance, then this NOT FORcompensation SALE OR for DISTRIBUTIONlost functions and restitution of func- NOTcan FOR also beSALE achieved OR usingDISTRIBUTION the feet or the mouth if tions (Bastian, 1898). He described therapy for apha- circumstances require. For this reason, too, rigid sia based on the potential of reorganization of the allocation of functions to specific brain areas cannot right hemisphere through functional compensation, be assumed. which he distinguished© fromJones functional & Bartlett restitution. Learning, LLCFor Luria, language was also© Jones a functional & Bartlett system, Learning, LLC These processes have becomeNOT FORaxiomatic SALE in neuropsy OR DISTRIBUTION- and his classification of aphasiaNOT resulted FOR SALEfrom local OR- DISTRIBUTION chology and have a significant impact on how we plan ized injuries and their relationship to the respective and carry out therapy. components of language processing. He outlined a During World War II, A. R. Luria (1902–1977) classification that, while using different terminology, in Russia collected a mass of data from brain-injured is not dissimilar to classifications that others have soldiers© and Jones developed & Bartlett a functional Learning, systems approachLLC produced. However,© Jones the & underlying Bartlett causesLearning, of symp LLC- to the NOTbrain FORand language, SALE OR resulting DISTRIBUTION in a new per- toms can be differentNOT FOR for Luria. SALE In whatOR DISTRIBUTIONfollows, I have spective on the organization of cognition and lan- inserted Benson and Geschwind’s (1971) equivalent guage and a new classification of aphasia. Treatment “neoclassical” forms. Luria described dynamic apha- involved the reorganization of function, where intact sia (also called frontal aphasia), which is caused by © Jonesfunctional & Bartlett subsystems Learning, could LLC be used to compensate © Jonesa lesion &of Bartlettthe left prefrontal Learning, lobe anteriorLLC to the pre- for impaired ones, in speech, language, reading, and motor areas. The main features are an apparent lack NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION writing. Luria’s clinical approach had a major impact of a will to speak and a disturbance of inner speech. in Eastern Europe but also in the United Kingdom The individual can no longer make predicative state- and Australia. He was influenced by the pioneering ments or propositions, and production is limited to work of fellow Russian psychologists Pavlov and empty phrases. They can understand quite well and Vygotsky and has been© called Jones the &“last Bartlett giant” inLearning, the can LLC also name and repeat, although© Jones they &initiate Bartlett little Learning, LLC history of aphasia. NOT FOR SALE OR DISTRIBUTIONspeech without external stimulation.NOT FOR On the SALE neoclas OR- DISTRIBUTION The essential foundations of Luria’s approach are sical model, this is transcortical motor aphasia. easily accessible in The Working Brain (1973) and in Luria described two separate forms of motor Kagan and Saling (1992). His important early work is aphasia. A lesion of the inferior frontal areas of the Traumatic© Jones Aphasia ,& based Bartlett on data Learning, gathered from LLC World left premotor© zone, Jones which & corresponds Bartlett Learning, to Broca’s area, LLC War II,NOT and the FOR English SALE translation OR DISTRIBUTION appeared in 1970. leads to efferentNOT (kinetic) FOR SALE motor ORaphasia. DISTRIBUTION Individual His general neuropsychology was extensively devel- sounds are not problematic, but the problems occur oped in Higher Cortical Functions in Man (1980), and a when the patient has to switch from one articulation special issue devoted to Luria’s contribution to aphasia to another. The individual has a problem with the appeared in Aphasiology, edited by Kaczmarek (1995). production of linear schemes, which also has effects in © Jones & LuriaBartlett attempted Learning, to create LLC a synthesis of the local- © Jonesother domains, & Bartlett so writing Learning, is also impaired LLC in a similar NOT FORizationist SALE approach, OR DISTRIBUTION as represented by Wernicke or NOTfashion. FOR In SALE later stages OR ofDISTRIBUTION the condition, agrammatism Kleist, with the holistic approach. To Luria, neither emerges. Neoclassically, this is Broca’s aphasia. The

second motor aphasia, afferent (kinesthetic) motor claimed not to be a localizationist, but emphasized © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC aphasia, is characterized by problems finding the localizable “functional systems,” his model helped to NOT FOR SALEpositions OR of DISTRIBUTION the articulators necessary for speech, NOTand FORreintroduce SALE ORlocalization DISTRIBUTION and provide it with a more in milder forms there is confusion between similar dynamic and multidimensional perspective, rather phonemes. Phonemic confusions also occur in read- than the two-dimensional connectionist view of the ing and writing. The lesion is in the inferior region old or neoclassical model. of the left post-central© Jones parietal & Bartlettcortex, which, Learning, among LLC A historically significant© Jones study & of Bartlettthe effectiveness Learning, LLC other things, leadsNOT to theFOR impaired SALE interpretation OR DISTRIBUTION of of aphasia therapy wasNOT conducted FOR inSALE Edinburgh OR DISTRIBUTION by kinesthetic feedback. The neoclassical model calls this psychologist Oliver Zangwill and speech therapist form conduction aphasia. Edna Butfield and published in 1946 (Butfield & Sensory aphasia is caused by a lesion of the supe- Zangwill, 1946). Howard and Hatfield (1987) sug- rior© Jones and posterior & Bartlett regions Learning, of the temporal LLC lobe, which gested that© Jones the paper & Bartlett“was the first Learning, published LLC attempt approximately corresponds to Wernicke’s area, and NOT FOR SALE OR DISTRIBUTION to evaluateNOT the FOR efficacy SALE of ORtherapy DISTRIBUTION properly, and to indeed on the neoclassical model it would be called assess also the significance of specific factors, such Wernicke’s aphasia. Luria localized phonemic analysis as the form of aphasia and its aetiology” (p. 51). The in the secondary auditory cortex, and, while the indi- short paper described therapy for 66 cases of aphasia viduals have intact hearing, they cannot discriminate between the ages of 20 and 40 years, divided into a © Jones & Bartlettbetween, Learning, analyze, or LLCsynthesize similar phonemes,© Jones group & Bartlett that received Learning, treatment LLC within 6 months of the NOT FOR SALEwhich OR leads DISTRIBUTION to comprehension difficulties at the NOTlexi- FORonset SALE (Group OR 1) DISTRIBUTIONand a group whose treatment began cal level. Paraphasias and writing problems arise from after 6 months (Group 2). The study examines the impaired “phonemic hearing.” effects of spontaneous recovery in the second group. An injury to the middle gyrus of the temporal lobe Treatment was mainly based on Goldstein’s methods, is the underlying© cause Jones in acoustico-mnestic & Bartlett Learning, aphasia, LLCand the amount varied© between Jones 5 & and Bartlett 290 sessions Learning, LLC which causes an impairmentNOT FOR of SALE verbal memory OR DISTRIBUTION and the per individual. ProgressNOT was measured FOR SALE fairly grosslyOR DISTRIBUTION in preservation of repetition, comprehension, and fluent ratings of much improved, improved, or unchanged. speech but with paraphasic errors—a transcortical sen- “Speech” was judged to be much improved in one-half sory aphasia in neoclassical terms. Finally, in semantic of Group 1 and one-third of Group 2, but improve- aphasia, patients can understand the meaning of indi- ment in the other modalities did not appear to be sig- vidual© Jones words, & butBartlett they cannot Learning, grasp theLLC meaning of nificant© toJones the authors. & Bartlett Improvement Learning, did notLLC appear theNOT construction FOR SALE as a ORwhole; DISTRIBUTION there is also an impair- to be relatedNOT toFOR spontaneous SALE OR recovery. DISTRIBUTION ment of what Luria called logico-grammatical operations with a disturbance of simultaneous (and spatial) The New World Takes synthesis that affects not only linguistic but also spatial the Lead © Jones & Bartlettand praxic Learning, systems, acalculia, LLC and other problems ©can Jones & Bartlett Learning, LLC co-occur. The lesion covers most of the posterior left The decline in the massive influence of German NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION hemisphere in the parieto-temporo-occipital region. aphasiology, neurology, and science in general was Benson and Geschwind (1971) consider this form of strongly related to the defeat of Germany in World aphasia equivalent to anomia. War I and the shift in the focus of intellectual life On the face of it, Luria’s model seems similar to the English-speaking world, and with Weisen- to other major classifications,© Jones & Bartlett but Luria Learning, has clearly LLCburg and McBride (1935)© Jones there was & Bartletta shift in Learning,focus LLC different views onNOT the FORindividual SALE processes OR DISTRIBUTION (analy- across the Atlantic andNOT a new, FOR behavioral, SALE ORpsycho DISTRIBUTION- sis, synthesis, and integration) engaged in language; metric, anticlassification, and antilocalizationist his is a process model. Additionally, the possibility approach to aphasia developed in the United States. of aphasic symptoms being connected at different This was spearheaded by particular attention to linguistic© Jones levels & Bartlett on the Learning,basis of abstract LLC principles assessment© Jones and rehabilitation. & Bartlett Learning, Many classifications LLC isNOT implied—for FOR SALE instance, OR theDISTRIBUTION disturbance of the lin- of aphasiaNOT had FOR developed SALE ORin the DISTRIBUTION previous century, ear scheme, which shows itself in sound produc- but Weisenburg and McBride’s own was the simple tion, sentence production, and writing. Importantly, dichotomy of expressive or receptive aphasia (and Luria’s process model provides routes for the for- mixed expressive-receptive). mulation of strategies for rehabilitation because the The educational psychologist L. Granich (1947) © Jones & Bartlettmodel is Learning,flexible and LLCdynamic in contrast to the static© Jones developed & Bartlett therapy Learning, for 300 LLCwar veterans in Atlantic NOT FOR SALEclassical OR model DISTRIBUTION and the brain is conceptualized overNOT- FORCity SALE Hospital, OR New DISTRIBUTION Jersey, including 100 with apha- all as a dynamic and interactive system. While Luria sia and related disorders. Granich’s therapy was also

much influenced by Goldstein’s work, and he was not a form of information processing. Visual information © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC concerned with standardized testing or aphasic syn- proceeds to the angular gyrus via the primary visual NOT FORdromes. SALE He ORused DISTRIBUTION drilling and believed in the benefi- NOTcortex, FOR where SALE the OR visual DISTRIBUTION form is associated with a cial effects of hard work by patients and in the value corresponding auditory pattern. When the word is of the strategies that patients produced themselves, required for speech, a representation is passed on although his approach was mostly uneven and patchy to Broca’s area via the arcuate fasciculus, where its (Howard & Hatfield, 1987).© Jones & Bartlett Learning,production LLC is implemented ©by Jones the motor & Bartlett cortex. Learning, LLC Between 1940 and 1960,NOT JosephFOR SALEWepman OR (1907– DISTRIBUTIONNeoclassicism dominated worldNOT aphasiology FOR SALE from OR DISTRIBUTION 1985) and Hildred Schuell (1907–1970) developed the 1960s until the 1980s and still has a significant assessment and treatment approaches for different influence. aphasia types based heavily on significant auditory Wernicke’s classification was repackaged as stimulation© Jones and repetition. & Bartlett For Learning,them, the person LLC with the Boston classification© Jones & Bartlettand became Learning, internation LLC- aphasia had not lost language functions, but they had NOT FOR SALE OR DISTRIBUTION ally known. NOTBeside FOR considerable SALE OR research DISTRIBUTION activity become inaccessible. Language competence survived; in Boston, the influence of Boston was bolstered by it was language performance that was impaired and the Boston Diagnostic Aphasia Examination (BDAE) could be regained with the right kind of stimulation. developed by Harold Goodglass (1920–2002) and Therapy essentially entailed facilitating and stimulat- Edith Kaplan (Goodglass & Kaplan, 1972). It became © Jonesing & languageBartlett use. Learning, Improvement, LLC if it occurred, came © Jonesone of the& Bartlett most popular Learning, and widely LLC used aphasia NOT FORbecause SALE the OR patient DISTRIBUTION facilitated and integrated what NOTbatteries FOR everSALE produced, OR DISTRIBUTION has been translated many they already knew and did not learn new vocabulary times, and still appears to be a widely used clinical or grammatical forms. assessment in English-speaking countries (Katz et al., The principles of stimulation and repetition remain 2000). The main functions are the classification of important ones in present-day© Jones approaches & Bartlett to therapy. Learning, aphasia LLC into (neo)classical types© Joneson the basis & Bartlett of func- Learning, LLC Both Wepman and SchuellNOT developed FOR SALE test ORbatteries: DISTRIBUTION tional profiles that emerge fromNOT testing FOR and SALE the local OR- DISTRIBUTION Wepman developed the Language Modalities Test for ization of damage on the basis of this classification. Aphasia (LMTA) with Jones (Wepman & Jones, 1961). Brain imaging was in its infancy when the BDAE was Schuell saw aphasia as a single unitary condition that developed, and localization of structural lesions from could, however, occur with additional complications impaired functions was an important goal of aphasio- and symptoms,© Jones and & Bartlett she attached Learning, great value LLC to a logical and neuropsychological© Jones & Bartlett testing. Learning, However, theLLC detailedNOT assessment FOR SALEin all modalities OR DISTRIBUTION reflected in the ability of theNOT BDAE FOR to localize SALE damage OR DISTRIBUTION on the basis Minnesota Test for Differential Diagnosis of Aphasia of aphasia classification was unreliable, at best, and (MTDDA) (Schuell, 1955; Schuell et al., 1964) devel- the advent of brain imaging methods made the goal oped with detailed psychometric evaluation. This mostly obsolete. © Jonesbattery & Bartlett supported Learning, much clinical LLC assessment for reha- © Jones & Bartlett Learning, LLC bilitation in the English-speaking world well into the NOT FOR SALE OR DISTRIBUTION NOTCognitive FOR SALE NeuropsychologyOR DISTRIBUTION latter 20th century. New approaches were developing that would have a significant impact on how researchers and clinicians Neoclassicism and the Return approached aphasia. These approaches were emerg- to Localization© Jones & Bartlett Learning,ing LLC from the growth of experimental© Jones psycholinguis & Bartlett- Learning, LLC Boston neurologist NormanNOT FOR Geschwind SALE OR(1926– DISTRIBUTIONtics and developments in NOTinformation-processing FOR SALE OR DISTRIBUTION 1984) is mainly responsible for the return of lan- approaches to cognitive functioning. The cognitive guage localization as what is called neoconnectionism neuropsychological model that was developed in the or neoclassicism. Geschwind resurrected the early 1980s pioneered a shift away from grouping and Wernicke–Lichtheim notion that certain areas of the classifying aphasia. Instead, it advocated the devel- left hemisphere© Jones have& Bartlett a narrowly Learning, specialized LLC func- opment of single-case© Jones designs& Bartlett for therapy Learning, research LLC tion inNOT language FOR processing, SALE OR among DISTRIBUTION them especially (Coltheart, 1983;NOT McReynolds FOR SALE & ORKearns, DISTRIBUTION 1983), and Broca’s and Wernicke’s areas (Geschwind, 1974); good success with well-selected individuals began to the connection between Broca’s area and Wernicke’s be demonstrated. area via the arcuate fasciculus; and the angular gyrus The development of the cognitive neuropsycho- © Jonesmediating & Bartlett between Learning, visual and LLC auditory information, © Joneslogical model& Bartlett emerged Learning, from the LLC coming together NOT FORwhich SALE is important OR DISTRIBUTION for written speech and naming. NOTof FORpsycholinguistics, SALE OR DISTRIBUTIONsingle-case methods, the Geschwind (1974) described language processing as information-processing model, and a theory-driven

and hypothesis-testing approach to investigation. For microgenesis, the basic assumption is that © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC This approach was claimed to be preferable to the mental representations, actions, and affects emerge NOT FOR SALEcomparison OR DISTRIBUTION of mixed groups categorized accordingNOT FORfrom SALE a prehistory OR DISTRIBUTION that shapes their major structure, to the classical syndromes. Utilizing Jerry Fodor’s where there is an “unfolding” in microtime (seconds (1983) ideas on modularity, an idea inspired by Gall’s or fractions of seconds) that leads to an idea or an faculties, the model assumed that components of action that unfolds from deep to surface structure. cognition are organized© Jones in modules& Bartlett that Learning,are domain LLCWe are aware of the surface© Jones events—ideas, & Bartlett actions— Learning, LLC specific (computationsNOT FOR performed SALE byOR a DISTRIBUTIONmodule are but not the deep prehistory.NOT FOR Measured SALE in ORmillions DISTRIBUTION specific to that module only), associated with cir- of years, the temporal unfolding process is evolu- cumscribed brain structures, genetically determined tionary phylogenesis; measured over a lifetime, it and computationally autonomous, and independent is ontogenesis; and when over a second or less, the of© other Jones cognitive & Bartlett processes. Learning, The model LLC became well process© is Jones one of µgenesis, Bartlett Learning, a kind of instantaLLC - knownNOT FORfor its SALEbox-and-arrow OR DISTRIBUTION diagrams to conceptu- neous evolution.NOT FOR SALE OR DISTRIBUTION alize processing; the diagrams were used to repre- Although microgenetic theory is in the tradi- sent the stages and routes involved in activities, such tion of Hughlings Jackson, explanations for the as reading single words aloud, writing single words emergence of aphasic and other symptoms differs to dictation, and naming objects. The model can (Brown, 1988). For Hughlings Jackson, the earlier © Jones & Bartlettidentify whatLearning, is impaired LLC and retained by detailed© Jones stages & Bartlett in evolution Learning, and individualLLC development NOT FOR SALEhypothesis-driven OR DISTRIBUTION testing using psycholinguistiNOT- FORwere SALE released OR or DISTRIBUTION disinhibited from the control of cally controlled tests. It shares some features with higher levels; in microgenesis, disinhibition appears the Wernicke–Lichtheim model, not least its focus to have less relevance. A symptom represents not on single-word processing. Graves (1997) traced only the result of a released lower, more primitive the evolution of the© Jones traditional & Bartlett Wernicke–Lichtheim Learning, LLClevel but also a natural© part Jones of the & prehistory Bartlett ofLearning, the LLC model through theNOT subsequent FOR SALE modeling OR ofDISTRIBUTION Dejerine surface behavior. For NOTinstance, FOR the SALE uncontrollable OR DISTRIBUTION (1892), Liepmann (1920), and Geschwind (1965) pathological laughing or crying that is a common to the contemporary models of Marshall and New- symptom of pseudobulbar palsy is, on the Jackso- combe (1973) and Ellis and Young (1988). The nian model, a disinhibited primitive reaction that is model informs modern cognitive neuroscience and out of higher control due to the upper motor neu- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC has had a substantial impact on approaches to assess- ron lesion, whereas in microgenetic theory they are mentNOT and FOR treatment SALE of OR aphasia. DISTRIBUTION always NOTthere FORin the SALE deep structureOR DISTRIBUTION of the nervous system and part of the prehistory of the normal Microgenetic Theory response that is shaped into a normal response by While clearly dominant, the cognitive neuropsycho- later stages in the unfolding of the response. There- © Jones & Bartlettlogical paradigm Learning, was not LLC the only theoretical approach© Jones fore, & Bartlettin microgenetic Learning, theory, LLC symptoms are errors NOT FOR SALEto emerge OR DISTRIBUTION in the second half of the 20th century.NOT FORbut SALEnot deficits OR, andDISTRIBUTION they are viewed as achievements Microgenetic theory also developed, although it has of the cognitive processes underlying them. The sig- not had wide impact. The word microgenesis was nificant claim is that a symptom represents a nor- first introduced in English by Heinz Werner (1956), mal part of normal processing revealed by pathology (Brown, 1988). who adapted the© German Jones Aktualgenese & Bartlett inLearning, an article LLC © Jones & Bartlett Learning, LLC called “MicrogenesisNOT and FOR aphasia,” SALE thoughOR DISTRIBUTION Arnold NOT FOR SALE OR DISTRIBUTION Pick (1913) had explored the microgenetic idea in aphasia earlier. Jason Brown (1979, 1988) devel- The Treatment of Aphasia oped microgenetic theory further in recent decades. in the Latter 20th Century The theory is in the tradition of Jackson’s evolutionary© Jones levels of& Bartlettneural representation, Learning, LLC although dis- Many treatments© Jones and& Bartlett therapies Learning,developed from LLC often tinctNOT from FOR it. SALE “The idea OR ofDISTRIBUTION microgenesis developed opposingNOT theoretical FOR SALE approaches OR DISTRIBUTIONduring the latter half in the Würburg school of psychology . . . but the of the 20th century. It became increasingly clear that term was coined from the German Aktualgenese . . . an aphasic language disability can result in signifi- for the microtemporal unfolding of object represen- cant emotional and psychosocial impact, can have a © Jones & Bartletttations, conceivedLearning, as LLC a more or less instantaneous© Jones fundamental & Bartlett influence Learning, on relationships,LLC and can set NOT FOR SALErecapilulation OR DISTRIBUTION in cognition of patterns laid downNOT in FORup sociocommunicativeSALE OR DISTRIBUTION barriers within the person’s phylo-ontogeny” (Brown, 1988, p. 3). community.

In the second half of the 20th century, treatment where the speaker uses his or her intact visual route to © Jones & Bartlett Learning, LLC © Jonesapproaches & Bartlett and Learning, methods developed LLC from a range of the speech production system. NOT FORsources. SALE There OR DISTRIBUTIONwere principled treatments based NOT FORThe systematic SALE OR nature DISTRIBUTION of the cognitive neuro- on theoretical positions as well as more symptom- psychological approach had attractive features for atic treatments aimed at reducing or eliminating clinical work with aphasia and subsequently other specific aphasic features. In the 1970s, Frederick aspects of impaired cognition and began to have a Darley (1918–1999) and© Jones his students & Bartlett emphasized Learning, significant LLC impact on aphasia© Jones therapy. & TheBartlett model Learning, LLC the importance of the NOTintensity, FOR duration, SALE ORand DISTRIBUTIONtim- came with a model of assessmentNOT forFOR treatment SALE and OR DISTRIBUTION ing of therapy input (Darley, 1972). Data began an emphasis on the individual and their problems. to emerge on the best candidates for treatment; Howard and Patterson (1990) outlined three strat- thus, the age, educational background, time since egies for therapy that could work with the model: onset of© Jonesthe damage, & Bartlett and severity Learning, of the LLC apha- reteaching of© theJones missing & Bartlett information Learning, or miss LLC- sia began to emerge as important prognostic vari- ing rules or procedures based on detailed testing, NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ables. A range of group-based randomized clinical teaching a different way to do the same task, and trials (RCTs) were conducted in the late 20th cen- facilitating the use of impaired access routes. While tury but proved very difficult to design and carry these broad strategies for treatment are not new, out mainly because of the heterogeneous nature of the model’s main contribution has been in system- © Jonesaphasia & Bartlett and the Learning, failure to LLCspecify and systematize © Jonesatizing assessment,& Bartlett allowingLearning, a clearer LLC identification NOT FORtherapy SALE appropriately. OR DISTRIBUTION NOTof theFOR location SALE of OR impairments DISTRIBUTION within a hypotheti- Howard and Hatfield (1987) classified most cal model. A recent book (Whitworth et al., 2013) approaches into several main methodologies. There focuses on the therapeutic application of clinical are didactic methods, which aim to reteach lan- research findings from cognitive neuropsychological guage utilizing traditional© Jones and intuitive & Bartlett educational Learning, research. LLC It clearly and transparently© Jones presents & Bartlett excel- Learning, LLC methods from child andNOT foreign-language FOR SALE ORteaching. DISTRIBUTION lent examples, making it highlyNOT accessible. FOR SALE OR DISTRIBUTION In common with didactic methods are established The development of a cognitive neuropsychology– behavioral techniques, such as repetition, imitation, inspired single-case approach was much aided by modeling, prompting, and cuing. They are utilized the failure of RCTs to demonstrate that treatment in some hierarchically organized therapy approaches was efficacious or effective. A similar disenchant- for apraxia© Jones of speech, & Bartlett and contemporary Learning, computer- LLC ment with © medical-model,Jones & Bartlett classification-based Learning, LLC based NOTmethods FOR use SALE systematic OR DISTRIBUTIONbehavioral methods treatments wasNOT at leastFOR a SALEpartial causeOR DISTRIBUTION for a parallel (see chapters in Code & Muller, 1995, and Helm- shift to more everyday functional communication at Estabrooks & Albert, 1991). Treatments inspired by this time. Martha Taylor Sarno (1969) and Audrey the Boston model were developed, mainly by Nancy Holland (1980) were important in developing func- © JonesHelm-Estabrooks & Bartlett Learning, and Martin LLC Albert and colleagues © Jonestional approaches& Bartlett toLearning, assessment LLC and treatment. (for review, see Helm-Estabrooks & Albert, 1991). Approaches like Promoting Aphasics Communica- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Many of these approaches were designed for specific tive Effectiveness (PACE; Davis & Wilcox, 1985) types of aphasia or impairment, such as persevera- emphasized successful communication, not precise tion, and use systematic behavioral training hierar- oral naming or correct syntax. The main features of chies organized into steps and levels, such as Melodic the approach are that the therapist and patient par- Intonation Therapy (MIT),© Jones which aims& Bartlett to reestablish Learning, ticipate LLC equally as sender and© receiverJones of& messages;Bartlett Learning, LLC some speech by reorganizingNOT FORthe speech SALE production OR DISTRIBUTION interactions entail the exchangeNOT of newFOR information; SALE OR DISTRIBUTION process using melodic intonation, and Visual Action the person with aphasia chooses the modality or Therapy (VAT) for Broca’s or global impairments. methods of communication; feedback is based on Schuell’s language stimulation was a part of many the person with aphasia’s success in communicating treatments© Jones and universally & Bartlett utilized. Learning, Luria’s LLC (1970) the message;© and Jones it encourages & Bartlett writing, Learning, gesturing, LLC functionalNOT systems FOR SALE model OR formed DISTRIBUTION the basis for drawing, andNOT pointing. FOR SALE OR DISTRIBUTION approaches to the reorganization of function. Intact Reorganizational approaches were developed functional subsystems could substitute for impaired based on surviving right-hemisphere (RH) processing subsystems. For example, Luria suggested that letters in the 1980s and 1990s. These include MIT, which made of sandpaper could aid a reading impairment claims to utilize intact RH musical processing. Artifi- © Jonesvia & the Bartlett tactile system,Learning, and drawnLLC “articulograms” of © Jonescial languages & Bartlett made upLearning, of visual arbitraryLLC shapes or NOT FORthe SALElips producing OR DISTRIBUTION particular combinations of speech NOTsymbols FOR were SALE devised OR DISTRIBUTIONfrom work with chimpanzees, sounds were developed for severe apraxia of speech, and remarkable success was reported with globally

impaired patients, being able to use the systems people with disabilities facing increased social barriers © Jones & Bartlett Learning, LLC © Jones & Bartlettpropositionally. Learning, There LLC were also attempts to directly and oppression (Jordan, 1998). The main objective of NOT FOR SALEinfluence OR DISTRIBUTIONcognitive processing in the RH and stimuNOT- FORthe SALEsocial approach OR DISTRIBUTION to aphasic disability is to increase late latent RH language processes using lateralization successful participation in authentic communication techniques, such as dichotic listening and hemi-field events, focus on communication at the level of con- viewing, although it was never clear that improve- versation, provide communicative support systems ments observed ©were Jones due to & increasedBartlett RHLearning, involve- LLCwithin the speaker’s own© Jones community, & Bartlett and increase Learning, LLC ment (for review,NOT see FORCode, SALE1987). ORIn theDISTRIBUTION 1980s, communicative confidenceNOT FORand empower SALE OR speakers DISTRIBUTION treatments began to be developed that were delivered with aphasia (Simmons-Mackie, 1998). by microcomputers using mainly behavioral methods In recent years, evidence-based practice (EBP) (see the collection led by Katz, 1987). Intense stim- has emerged as a concept; it is essentially a principled ulation,© Jones feedback & Bartlett on performance, Learning, and LLC control of the and systematic© Jones approach & Bartlett to evaluating Learning, the LLC relative pace and level of difficulty by the user appeared to be strengths of a treatment for an individual. It com- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION clear advantages. bines clinical expertise, best current evidence, and Also, during the early 1980s, the relevance of the client values with the aim of providing the highest- psychosocial impact of aphasia began to be better rec- quality service reflecting the needs and choices of ognized, although Goldstein had pioneered its impor- the individual (Sackett et al., 2000). This process of © Jones & Bartletttance before Learning, World War LLC II. Most of our happiness ©and Jones evaluation & Bartlett is aided Learning, in practice LLC with the range of sys- NOT FOR SALEsadness OR come DISTRIBUTION from our interactions with others. HowNOT FORtematic SALE reviews OR ofDISTRIBUTION therapy trials available, and there we perceive our interactions with others is what deter- are a range of useful resources that can help with mines the quality of our life experience—our psycho- what could be time consuming for a busy clinician. social well-being. Our psychosocial life is grounded Both the American Speech and Hearing Associa- in our emotional© experience Jones & within Bartlett a social Learning, context. LLCtion (ASHA) and Academy© Jones of Neurogenic & Bartlett Commu Learning,- LLC The psychosocialNOT impact FOR of aphasia SALE onOR people DISTRIBUTION with nication Disorders andNOT Sciences FOR (ANCDS) SALE OR provide DISTRIBUTION aphasia and their families began to be increasingly detailed evaluations of evidence for the effectiveness acknowledged, and approaches to improving psycho- of aphasia treatment that are freely available online social state began to be developed (see the collection (http://www.asha.org; http://www.ancds.org/evidence of papers in Code, 1999, and Code et al., 1999). In -based-practice-guidelines). SpeechBite is a free web 1980,© Jones the World & Bartlett Health Learning,Organization LLC (WHO) intro- resource© Jonesthat enables & Bartlett searching Learning, for approaches LLC to ducedNOT theFOR terms SALE impairment, OR DISTRIBUTION disability, and handicap to therapyNOT across FOR the specialties SALE OR of speechDISTRIBUTION and language describe and categorize disease. In this latter part of therapy and pathology including aphasia and related the 20th century, the disability movement was suc- conditions (http://www.speechbite.com/). It provides cessful in introducing a social model that contrasted an online database established to gain fast access to © Jones & Bartlettsignificantly Learning, with the LLC medical model’s perspective© Jones evaluated, & Bartlett relevant, Learning, evidence-based LLC research for clini- of illness, and the social disability and social exclu- cal decision making, contains references to more than NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION sion that accompany aphasia became increasingly 3,000 journal articles, and provides methodological acknowledged. reliability ratings to help identify the research quality The more recent draft of the International Clas- of therapy trials (Murray et al., 2013). The Aphasia sification of Impairments, Disabilities, and Health Software Finder, developed at Frenchay Hospital, (WHO, 2001) proposed© Jones three & Bartlett dimensions: Learning, impair- LLCBristol, United Kingdom,© Jonesand funded & Bartlett by the TavisLearning,- LLC ment, a loss or abnormalityNOT FOR of SALE body structure OR DISTRIBUTION or of a tock Trust, provides an NOTonline FORservice SALE for people OR withDISTRIBUTION physiological or psychological function; activity lim- aphasia and their families, as well as professionals, itation, where the extent of functioning at the level of for locating relevant computer treatment software the person is reduced or limited. Activities may be packages and also provides evaluation (http://www limited© Jones in nature, & Bartlett duration, Learning, and quality. LLC The term dis- .aphasiatavistocktrust.org/aphasia/default/software© Jones & Bartlett Learning, LLC abilityNOT wasFOR replaced SALE by OR activity DISTRIBUTION limitation. Participation .asp) (FurtherNOT FOR detailed SALE discussion OR DISTRIBUTION of EBP can be found is the nature and extent of a person’s involvement in in Chapter 7.) life situations in relation to impairments, activities, To end this brief sketch of the history of apha- health conditions, and contextual factors. Handicap sia and its treatment, we might ask whether things was replaced by participation restriction. got any better for people with aphasia in the 20th © Jones & BartlettThis Learning,approach sees LLC the problem lying not in ©the Jones century. & Bartlett At the Learning,turn of the century, LLC Katz et al. (2000) NOT FOR SALEindividual’s OR DISTRIBUTION impairments but rather in society’s failureNOT FORconducted SALE anOR international DISTRIBUTION survey across the English- to accommodate their different needs, which lead to speaking world, with data collected from clinical

aphasia departments in the United States, Canada, service we provide to people with aphasia does not © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Australia, and the United Kingdom. Findings revealed appear to be narrowing. NOT FORthat SALE the mean OR amount DISTRIBUTION of therapy per week received at NOT FORWhat SALEcould a ORfuture DISTRIBUTION history of aphasia look like? the acute stage was just 30 minutes for Australia and As noted elsewhere (Tesak & Code, 2008), predict- the United Kingdom. For North America, the mean ing the future may well be imprudent given the very was 60 minutes per week but with a range of 16 to 20 unpredictable nature of future events, especially since sessions (the North American© Jones data & included Bartlett the Learning, Vet- the LLC global financial crisis ©of Jones2007–2008, & Bartlett a world- Learning, LLC eran’s Administration hospitalNOT FORsystem). SALE The figures OR DISTRIBUTION for wide economic crisis that negativelyNOT FOR impacted SALE finan OR- DISTRIBUTION the United Kingdom and Australia in particular sug- cial support for health and social services in many gest that people with aphasia, even in the acute stage, of the world’s economies. At the time of this writ- can expect no more than 2.5 hours of therapy spread ing, the impact of the 2020 worldwide COVID-19 over 5 ©weeks. Jones The & amount Bartlett of therapyLearning, someone LLC with pandemic is unknown,© Jones but & Bartlettthe damage Learning, to the world’s LLC more long-term aphasia can expect is even less (see economies will be colossal. However, trends in NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION the collection of studies of the treatment of chronic health care and public health suggest that the inci- aphasia edited by Code, 2010). dence of stroke in the 40-to 60-year-old age range Yet there is evidence that intensive therapy, even will decrease, at least in the developed world, as relatively short in duration, can improve outcome, improved medical interventions result in an increase © Jonesespecially, & Bartlett but Learning,not exclusively, LLC in the early stages of © Jonesin survival & Bartlettfrom stroke Learning, and improved LLC awareness of NOT FORrecovery. SALE Bhogal OR DISTRIBUTION et al. (2003) conducted an analy- NOTthe FORimportance SALE of OR diet, DISTRIBUTION exercise, and lifestyle makes sis of the large group trials that have been completed an impact. But people are living longer, and this over the years that have examined the effectiveness brings with it an increase in the incidence of pro- of aphasia treatment. They found a significant treat- gressive neurological conditions, including progres- ment effect in studies© that Jones provided & Bartlett 8.8 hours Learning, of sive LLC aphasia. So aphasia will© be Jones with us& Bartlettfor many Learning, LLC weekly therapy for 11.2NOT weeks; FOR studies SALE that OR did DISTRIBUTION not years yet, and its managementNOT will FORcontinue SALE to be OR a DISTRIBUTION show a significant treatment effect provided less than significant concern for the foreseeable future. 2 hours for 23 weeks. The implication of these results What might be the nature of this management of seems clear: Intensive therapy over a relatively short aphasia? Predictions suggest that pharmaceutical and duration can be more effective and cost effective neurophysiological interventions will emerge but will than nonintensive© Jones & therapy Bartlett over Learning, twice the LLCduration be coupled with© Jones behavioral & Bartlett assessment Learning, and treatment LLC (for a NOTthorough FOR discussion SALE ORof therapy DISTRIBUTION intensity, see carried out NOTby trained FOR andSALE experienced OR DISTRIBUTION clinicians Patterson et al., 2018). (Small, 2000, 2004). Methods of treatment have improved consider- Broca, Wernicke, Hughlings Jackson, and their ably over the centuries, and a great deal of research contemporaries might be surprised and rather dis- © Jonesinto & Bartlettrehabilitation Learning, demonstrates LLC that it can be effec- © Jonesappointed & Bartlettthat aphasia Learning, still constitutes LLC a significant tive. People with aphasia do receive treatment, in the problem for many in the early 21st century, but cur- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION developed world at least, but the gap between what rent developments in treatment and management we know about the effectiveness of treatment and the should provide some optimism for the future.

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION WRAP-UP © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC StudyNOT Questions FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1. When in the history of aphasia did 2. What were the main trends that caused a shift thinkers associate damage to the brain of focus in aphasia research from Europe to with impairments in speech and language? North America? © Jones & BartlettDescribe Learning, the main forms LLC of aphasia © Jones3. What & Bartlett single event Learning, is often suggested LLC to NOT FOR SALEidentified OR DISTRIBUTION by the Wernicke–Lichtheim NOT FORhave SALE heralded OR the DISTRIBUTION beginnings of modern model. aphasiology?

4. Why was Gall’s organology (Spurzheim’s 7. In what ways did Arnold Pick describe © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC phrenology) so revolutionary, and in which ways and distinguish agrammatism from NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION is it an inadequate theory of the relationship paragrammatism? between brain structure and brain function? 8. Who has been called the father of aphasia 5. Who developed the so-called speech. therapy? gymnastics approaches to aphasia treatment? 9. Stimulation plays a particularly significant role 6. Writers in previous© Jones times & Bartletthave described Learning, LLC © Jones & Bartlett Learning, LLC aphasia as aNOT memory FOR disorder. SALE Why? OR DISTRIBUTIONDoes the in the history of theNOT treatment FOR SALEof aphasia. OR With DISTRIBUTION idea that various aphasic impairments may be whom is the idea associated? caused by some impairment in memory have 10. Who developed a more systematic and relevance today? psychometric approach to testing for aphasia? © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ReferencesNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Baillarger, J. G. F. (1865). De l’aphasie au point de vue psychologique. Code, C. (Ed.). (1999). Management of psychosocial issues in Masson. aphasia. Seminars in Speech and Language, 20, 1–92. Bastian, H. C. (1898). A treatise on aphasia and other speech defects. Code, C. (Ed.). (2010). Treatment of chronic aphasia: International H. C. Lewis. perspectives. Seminars in Speech and Language, 31, 3–75. © Jones & BartlettBateman, F. Learning, (1890). On aphasia, LLC or loss of speech, and the localization© Jones Code, & BartlettC., Hemsley, Learning, G., & Herrmann, LLC M. (1999). The emotional NOT FOR SALEof theOR faculty DISTRIBUTION of articulate language (2nd ed.). J. & A. Churchill.NOT FOR impactSALE of aphasia.OR DISTRIBUTION Seminars in Speech and Language, 20, 19–31. Bennett, M. R., & Hacker, P. M. S. (2003). Philosophical foundations Code, C., & Müller, D. J. (Eds.). (1995). Treatment of aphasia: of neuroscience. Blackwell. From theory to practice. Whurr Publishers. Benson, D. F., & Geschwind, N. (1971). Aphasia and related Coltheart, M. (1983). Aphasia therapy research: The single-case cortical disturbances. In A. B. Baker & L. H. Baker (Eds.), study approach. In C. Code & D. J. Müller (Eds.), Aphasia Clinical neurology ©(pp. Jones 112–140) &. Harper Bartlett & Row. Learning, LLC therapy (pp. 193–202). Edward© Jones Arnold. & Bartlett Learning, LLC Benton, A. L. (1965). Johann A. P. Gesner on aphasia. Medical Darley, F. L. (1972). The efficacy of language rehabilitation in History, 1, 54–60.NOT FOR SALE OR DISTRIBUTIONaphasia. Journal of SpeechNOT and Hearing FOR Research, SALE 37 , OR3–21. DISTRIBUTION Benton, A. L. (1988). Pitres and amnesic aphasia. Aphasiology, 2 Darwin, C. (1859). On the origin of species by means of natural (3-4), 209–214. https://doi.org/10.1080/02687038808248911 selection, or the preservation of favoured races in the struggle for Bhogal, S. K., Teasell, R., & Speechley, M. (2003). Intensity of life. Murray. aphasia therapy, impact on recovery. Stroke, 34, 987–993. Davis, G. A., & Wilcox, M. J. (1985). Adult aphasia rehabilitation. Bogen,© Jones J. (1969). & BartlettThe other side Learning, of the brain II:LLC An appositional Applied© pragmaticsJones . &College-Hill Bartlett Press. Learning, LLC NOTmind. FOR Bulletin SALE of the LosOR Angeles DISTRIBUTION Neurological Societies, 34r, Dax, M.NOT (1865). FOR Lésions SALE de la ORmoitié DISTRIBUTION gauche de l’encéphale 135–162. coincidant avec l’oubli des signes de la pensée - Lu au congrès Breasted, J. H. (1930). The Edwin Smith surgical papyrus (Vol. 1–2). méridional tenu à Montpellier en 1836 [Lesions of the left half University of Chicago Press. of the brain coinciding with forgetting the signs of thought - Broca, P. (1861). Perte de la parole, ramollissement chronique Read at the southern congress held in Montpellier in 1836]. de destruction partielle du lobe antérieur gauche du cerveau. Gazette Hebdomadaire de Médecine et de Chirurgie, 2(2nd ser.), © Jones & BartlettBulletins Learning, de la Société d’AnthropologieLLC de Paris (séance du© 18 Jones & Bartlett Learning, LLC 259–260. avril), 235–238. NOT FOR SALE OR DISTRIBUTION NOT FORDejerine, SALE J. (1891). OR DISTRIBUTIONSur un cas de cécité verbale avec agraphie Broca, P. (1863). Localization des fonctions cérébrales. Siège du suivi d’autopsie. Mémoires de la Société de Biologie, 3, 197–201. langage articulé. Bulletins de la Société Anthropologique de Paris (séance du 2 avril), 200–204. Dejerine, J. (1892). 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Freud, S. (1953). On aphasia: A critical study. International of aphasia management practices. International Journal of © Jones &Universities Bartlett Press. Learning, (Original work LLC published in 1891). © JonesLanguage & &Bartlett Communication Learning, Disorders, 35LLC, 303–314. NOT FORGall, SALE F. J. (1798). OR Des DISTRIBUTION Herrn F. J. Gall Schreiben über seinen bereits NOTKleist, FOR K. (1914). SALE Aphasie OR und DISTRIBUTION Geisteskrankheit [Aphasia and mental geendigten Prodromus über die Verrichtungen des Gehirns illness]. Muenchner Medizinische Wochenschrift, 60(1), 8–12. der Menschen und der Thiere an Herrn Jos. Fr. von Retzer. Kleist, K. (1916). Die Leitungsaphasie und grammatische Störungen. Der Neue Teutsche Merkur, 3, 311–332. (Wiederabgedruckt in Monatsschrift für Psychiatrie und Neurologie, 40, 118–199. Lesky, 1970). Levelt, W. J. M. (1989). Speaking: From intention to articulation. Garrett, M. F. (1980). 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(1973).NOT FORThe working SALE brain: OR An DISTRIBUTION introduction to related disorders. Lea & Febiger. neuropsychology. Penguin. Granich, L. (1947). Aphasia: A guide to retraining. Grune & Stratton. Luria, A. R. (1980). Higher cortical functions in man (2nd ed.). Basic Graves, R. E. (1997). The legacy of the Wernicke-Lichtheim Books. model. Journal of the History of Neurosciences, 6, 3–20. Marie, P. (1906). Révision de la question sur l’aphasie: La © JonesHalliday, & Bartlett M. A. K. Learning, (1961). Categories LLC of the theory of grammar. © Jonestroisième & Bartlettcirconvolution Learning, frontale gauche LLC ne joue aucun rôle Word, 17, 241–292. spécial dans la fonction du langage. La Semaine Médicale, 26, NOT FORHalliday, SALE M. A. OR K. (1985).DISTRIBUTION An introduction to functional grammar. NOT 241–247.FOR SALE OR DISTRIBUTION Edward Arnold. Marshall, J. C., & Newcombe, F. (1973). Patterns of paralexia. Hanley, R., & Kay, J. (2003). Monsieur C: Dejerine’s case of alexia Journal of Psycholinguistic Research, 2, 175–199. without agraphia. In C. Code, C.-W. Wallesch, Y. Joanette, & McReynolds, L. V., & Kearns, K. P. (1983). Single-subject A. R. Lecours (Eds.), Classic cases in neuropsychology: (Vol. II, experimental designs in communicative disorders. University Park pp. 57–74). Psychology Press.© Jones & Bartlett Learning, LLCPress. © Jones & Bartlett Learning, LLC Head, H. (1926). Aphasia andNOT kindred FOR disorders SALE of speech OR (Vols.DISTRIBUTION Miller, G. A. (1964). The psycholinguistics.NOT Encounter,FOR SALE 23, 29–37. OR DISTRIBUTION 1–2). Macmillan Company. Murray, E., Power, E., Togher, L., McCabe, P., Munro, N., & Helm-Estabrooks, N., & Albert, M. L. (1991). Manual of aphasia Smith, K. (2013). The reliability of methodological ratings for therapy. Pro-Ed. speechBITE using the PEDro-P scale. International Journal of Holland, A. (1980). Communicative Abilities in Daily Living [CADL]: Language & Communication Disorders, 48, 297–306. A test© of functionalJones communication& Bartlett for Learning, aphasic patients .LLC University Nespoulous, J.-L.,© Code,Jones C., Virbel,& Bartlett J., & Lecours, Learning, A-R. (1998). LLC Park Press. Hypotheses on the dissociation between “referential” Howard,NOT D., & Hatfield,FOR SALE F. M. (1987). OR Aphasia DISTRIBUTION therapy: Historical and “modalizing”NOT FORverbal SALEbehaviour OR in DISTRIBUTIONaphasia. Applied and contemporary issues. Erlbaum. Psycholinguistics, 19, 311–331. Howard, D., & Patterson, K. (1990). Methodological issues in Paradis, M. (1981). Acquired aphasia in bilingual speakers. In M. neuropsychological therapy. In X. Seron, & G. Deloche, Taylor Sarno (Ed.), Acquired aphasia (3rd ed., pp. 531–549). Cognitive approaches in neuropsychological rehabilitation (pp. Academic Press. © Jones &39–64). Bartlett Lawrence Learning, Erlbaum Associates. LLC © JonesParadis, M. & (Ed.).Bartlett (1983). Learning, Readings on aphasia LLC in bilinguals and NOT FORIsserlin, SALE M. (1922).OR DISTRIBUTION Über Agrammatismus. Zeitschrift für die NOT polyglotsFOR .SALE Marcel Didier. OR DISTRIBUTION gesamte Neurologie und Psychiatrie, 75, 332–410. Patterson, J., Raymer, A., & Cherney, L. (2018). Treatment Jakobson, R. (1941). Kindersprache, Aphasie und allgemeine intensity in aphasia rehabilitation. In P. Coppens & J. Patterson Lautgesetze. Universitets Arsskrift. (Eds.), Aphasia rehabilitation: Clinical challenges (pp. 291–329). Jakobson, R. (1964). Towards a linguistic typology of aphasic Jones & Bartlett Learning. impairments. In A. de Reuck & M. O’Connor (Eds.), Disorders Pick, A. (1913). Die agrammatischen Sprachstörungen [The of language (pp. 223–246).© Churchill. Jones & Bartlett Learning, LLCagrammatic speech disorders]. Springer-Verlag.© Jones & Bartlett Learning, LLC Jakobson, R. (1968). ChildNOT language, FOR aphasia SALE and phonologicalOR DISTRIBUTION Pitres, A. L. (1895). Etude sur l’aphasieNOT chezFOR les SALE polyglottes OR. DISTRIBUTION universals. De Gruyter Mouton. Revue de Médecine, 15, 873–899. (Translated in Paradis, 1983, Jordan, L. (1998). Partners in care. Bulletin of the Royal College of 26–49.) Speech & Language Therapists, August, 7–8. Pitres, A. L. (1898). L’aphasie amnésique et ses variétés cliniques. Alcan. Joynt, R., & Benton, A. (1964). The memoir of Marc Dax on Ribot, T. (1881). Les maladies de la mémoire. G. Baillère. aphasia.© Jones Neurology &, 14, Bartlett 851–854. Learning, LLC Sackett D. L., Strauss© Jones S. E., Richardson & Bartlett W. S., Learning, Rosenberg, W., LLC & Kaczmarek,NOT B. L.FOR J. (Ed.). SALE (1995). OR Special DISTRIBUTION issue for A. R. Luria. Haynes, R. B.NOT (2000). FOR Evidence-based SALE medicine:OR DISTRIBUTION How to practice Aphasiology, 9, 97–206. and teach EBM (2nd ed.). Churchill Livingstone. Kagan, A., & Saling, M. (1992). An introduction to Luria’s aphasiology: Schiller, F. (1992). Paul Broca, founder of French anthropology, Theory and application (2nd ed.). Witwatersrand University Press. explorer of the brain. Oxford University Press. Katz, R. C. (1987). Efficacy of aphasia treatment using Schuell, H. (1955). Minnesota test for differential diagnosis of microcomputers. Aphasiology, 1, 141–175. aphasia. University of Minnesota. © JonesKatz, & BartlettR. C., Hallowell, Learning, B., Code, LLCC., Armstrong, E., Roberts, P., © JonesSchuell, H., & Jenkins, Bartlett J. J., &Learning, Jiménez-Pabón, LLC E. (1964). Aphasia in NOT FOR Pound,SALE C., OR & Katz, DISTRIBUTION L. (2000). A multi-national comparison NOT adults:FOR Diagnosis, SALE prognosis, OR DISTRIBUTION and treatment. Harper & Row.

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