1. Aphasiology: Historical Overview
William F. Katz, Ph.D.
COMD 7302

2. Early History
Egypt
Hebrews
Greece
Rome

3. Edwin Smith surgical papyrus
BCE
5 meters long
50 + cases, ordered head  foot (but stopped at the thorax)
Language and speech not linked to thought, not considered essential to humanity
In describing temporal lobe wound: “something entered from the outside… the patient was silent in sadness”

4. Hebrew writings Loss of speech does not imply loss of soul
Soul located in heart
Unity of the soul: Mental faculties are not fractional

5. Greeks - Homer Legendary blind poet – perhaps fictional (?)
Probably lived in 9th – 11th C BCE
Author of Iliad and Odyssey – recorded ~700 BCE
Two types of speechlessness:
Aphasia – loss of speech due to emotion
Anaudos – loss of the human faculty of language

6. Sophocles:
BCE
Famous Athenian playwrite (Electra; Oedipus Rex)
Introduced the term:
Aphonos - Loss of speech/voice

7. Greeks – Hippocrates ~ 400 BCE Father of modern medicine
Noted individual differences in severity of disease symptoms
Thoughts, ideas, and feelings come from the brain and not the heart
“an incised wound in the temple produces a spasm in the opposite sides of the body”
“Speechlessness follows convulsions with paralysis of tongue”

8. Hippocrates
Aphonos attributed to “excessive repletions of blood vessels” (i.e., stroke)
Head injury as source of speech loss
Correlation between paralysis and speech loss

9. Plato Nickname, literally “broad” (shoulders) 427-327 BCE
Founded the first Academy (from a Cademus – the land of cademus)
Philosopher, mathematician
           

10. Plato
Thought = “Inner speech”

11. Aristotle (384-322 BCE) Philosopher, logician, politician
Distinguished voice, articulation, and speech
Proposed organs unique to each
Speech = product of reason
Reason comes from the senses

12. Aristotle
Political origins of language

13. Romans 30 CE Valerius Maximus 1rst case of traumatic alexia
Early localization of brain functions assigned to ventricles

14. Galen (CE 131 – 200) “Head centered” view of aphasia
Origins of ventricular theory of brain activity
Language as unique to and defining of humanity (from Stoic philosophy)

15. From Rome to the middle ages
Justinian code (539 CE):
Speech as a requisite for Roman citizenship
Christian middle ages:
Speech is a property of the soul
Not a topic of scientific inquiry

16. Byzantine and Arab tradition
Neuroanatomy: Sites of function
Ventricles, Meninges
Neurophysiology (Greek Tradition)
The four humors:
Blood
Phlegm
Yellow bile (“choler”)
Black bile (“melancholy”)

17. Medieval Renaissance Return of medical science
Clinical observation and translation
Emergence of Universities
Dissections permitted at Bologna (1326)
Role of the great plagues

18. Andreas Vesalius (1500s)
First insights into activity of the nervous system.
“Nerves serve the same purpose to the brain that the great artery does to the heart, and the vena cava to the liver, in as much as they convey to the instruments to which it ought to be sent the spirit prepared by the brain, and hence may be regarded as the busy attendants and messages of the brain”
End of the ventricle theory

19. Sample work of Vesalius

20. Modern history of aphasia
Post-enlightenment
Strong European contributions

21. Localizationists vs. holists
(background: Rene Descartes)
( )
Franz Joseph Gall
Jean Pierre Flourens
Jean-Baptist Bouillaud
Pierre Gratiolet
Ernest Aubertin
Armand Trousseau
Paul Broca
John Hughlings Jackson
Marc Dax
Paul Pierre Marie
Carl Wernicke
Sigmund Freud
Ludwig Lichtheim
Sir Henry Head
Adolf Kussmaul
Constantine von Monakow
Arnold Pick
Kurt Goldstein

22. Localization vs. Holism - Overview

23. Franz Joseph Gall
Highly-respected neuroanatomist

24. Gall
Psychological functions are separate and located in the cortex in separate places
Functions or faculties are innate
Bigger size – more developed function
Emphasis on empirical study, unity of function and
Structure (function is primary)
Size of brain regions in SPECIAL cases can be figured out from bumps on the skull
His student, Johann Spurzheim, promulgated the notion of “phrenology”. This discredited notion was connected with Gall for many years.

25. Gall – main insights
Contralateral organization of neural control over bodily functions
Distinction between grey and white matter
Origins of cerebral convolutions in the growth and folding of the developing brain
Nerves do not all descend from a single brain

26. Jean-Baptiste Bouillaud
Kept Gall's ideas alive during the long winter of its official disrepute.
Known for a description of loss of speech in the absence of paralysis of the tongue
Bouillaud's Wager

27. Bouillaud
1825 treatise sparked a revival of interest in Gall and language localization

28. Ernest Aubertin Son-in-law of Bouillaud
1861 mentioned a patient with traumatic frontal cranial deficit. When he applied light pressure while the patient was speaking he would stop in midword.
Worked with Broca at Bicetre
Contributed to Broca’s famous case of Leborgne
Specified the connection between anterior brain damage and loss of speech

29. Pierre Paul Broca
French pathologist, anthropologist, neurosurgeon
Also a craniometrist
From relatively progressive Huguenot background
Founded the Anthropological Society to join Darwin in opposing the immutability of races
Dissociates from phrenology, but works on Bouillaud’s wager
Published over 500 scientific papers

30. Broca
Localizes faculty of articulate speech in third frontal convolution “aphemia”
Makes key contributions on laterality “we speak with the left hemisphere”
Important links between laterality and handedness

31. Broca's Drawing

32. M. Leborgne's Brain “Tan tan”

33. Lelong’s brain – details

36. Marc Dax
Correlated loss of speech with right hemiplegia, due in some cases to known LH trauma
Some argue he should have received the credit for Broca’s localizationist claims because he made the discovery 25 years earlier

37. Karl Wernicke
Prussian-born German neurologist and psychiatrist
Published Der aphasische Symptomenkomplex at age 26

38. Wernicke
Introduced important concept of reflex arc and physiological vocabulary
Careful description of functional disturbances as well as pathological detail
Model has predictive value
Birth of information processing models

39. Wernicke's Arc, 1874

40. Ludwig Lichtheim 1845-1928 German physician
Über Aphasie. Deutsches Archiv für klinische Medicin, Leipzig, 1885
Important modeling work (see next slide)

41. Lichtheim's Model Accounts for Transcortical motor aphasia
Deep dysphasia

42. Adolf Kussmaul 1822-1902 German internist
Expert in psychology, psychological chemistry, pathology, and neurology
Identified “agrammatism”, inspired linguistic models (see next slide)

43. Kussmaul's Model  Accounts for: 1. Isolated anomia
2. Isolated comprehension
3. Knowledge of phonologic
information without being able to speak

44. Wernicke/Lichtheim model

45. Localizationists vs. holists
(background: Rene Descartes)
( )
Franz Joseph Gall
Jean Pierre Flourens
Jean-Baptist Bouillaud
Pierre Gratiolet
Ernest Aubertin
Armand Trousseau
Paul Broca
John Hughlings Jackson
Marc Dax
Paul Pierre Marie
Carl Wernicke
Sigmund Freud
Ludwig Lichtheim
Sir Henry Head
Adolf Kussmaul
Constantine von Monakow
Arnold Pick
Kurt Goldstein

46. Rene Descartes
Perhaps the most important philosopher and scientist in Western history
Many linguists and cognitive scientists consider themselves “Cartesians”

47. Cogito Ergo Sum
The only certainty Descartes felt was that he could doubt
But, through doubting: Doubting was thinking Thinking required a thinker Therefore he did, in fact, exist
Hence:  I think, therefore I am

48. Innate Ideas Innate ideas were natural components of the mind
Some ideas were so clear and distinctive they had to be true, even without personal experience
Descartes had ideas that were perfect, even if he wasn’t
Descartes could not have had these ideas on his own
Therefore GOD put those ideas into a person’s head
Some Innate Ideas: Unity/Infinity/Perfection

49. Descartes’ Contributions
Mechanistic views on behavior
These views influenced: - Behaviorism - Stimulus – Response Psychology - Comparative Psychology - Physiological Psychology
Re-focused Conflict - Animal vs. Human - Rational vs. Irrational
Notion of “Mind” Permitted study of consciousness

50. Descartes
His dualistic model of mind and body (“substance dualism”) denied the mind any materializability or localizability.
Therefore, his legacy tended to work against the localizationist concept.

51. Flourens
Experimental localizer in the nervous system (e.g., motor functions in the cerebellum) but opposed to localization of higher cerebral function
Strong opponent of Gall
Pigeon experiments
Cortical stimulation experiments
Also used philosophical arguments of notion of self and free will

52. Louis-Pierre Gratiolet
French physiologist and anatomist ( )
Wrote “Memory on the cerebral folds of the man and the primates and “Comparative anatomy of the nervous system”
Opposed Broca and Aubertin
Felt that different intellectual functions could not be localized in different regions of the brain

53. Armand Trousseau (1801-1867) Introduced the term “Aphasia”
(Greek) a, “not”; phanai, “to speak”
Suggested replacing Broca’s original “aphemia” - thought this meant “infamy” in Greek (NOTE: It doesn’t)
Pioneering work in diphtheria, haemochromatosis, Parkinson's disease, aphasia

54. John Hughlings Jackson
British
Founder of cognitive school
Aphasia = loss of the ability to express propositions
Levels of inhibition and disinhibition

55. Jackson
“To locate the lesion which destroys speech and to locate speech are two different things”
Demanded empirical evidence
His work presaged later concepts of automatic vs. controlled processing

56. Pierre Marie 1853-1940 French clinical neurologist
Studied with Broca and Charcot
Disapproved of the dogma of the 3rd frontal convolution

57. Sigmund Freud Perhaps best known physician of modern times
Trained as a neurologist, practiced in Vienna
A student of Charcot
Later in his career - founder of psychoanalysis (“the talking cure”)
Originally concerned with hysteria

58. Freud Zur Auffassung der Aphasien (1891) Influenced by Jackson
Hierarchy, preconscious
Criticizes Lichtheim's model on its own predictions: internally inconsistent

59. Freud “Cortical fields” theory
First order (verbal) – highest integrative function/ Second order (asymbolic) disturbance of the speech area in relation to surrounding functional organization/ Third order (agnostic) difference in relations between secondary areas
A hybrid theory – can explain why a lesion in one area can have different presentations in different people; but retains key concepts of earlier localizationist models

60. Sir Henry Head
(1927) “Aphasia and kindred disorders of speech”
Language is not just words
Abstract attitude; catastrophic reaction
Anti-mechanistic

61. Head Extensive study of injuries from WWI
Ridiculed the “diagram makers”
Stressed the symbolic nature of language
Stop conceiving of language as words

62. Constantine von Monakow
Russian-born scientist
In Switzerland, named Professor of Neurology in 1894.
Promoted “diaschisis” the breaking up of a pattern of brain activity by a localized injury that temporarily throws the whole activity out of function though destroying only part of a structure
Noted how symptomotology can change over time

63. Arnold Pick 1851-1924 Czech-born German psychiatrist and neurologist
10 stages of psycholinguistic processing in speech production
Precursor to modern psycholinguistic models

65. Pick – cont’d

66. Kurt Goldstein 1878-1965 Comparative neurology and neuropsychology
Studied medicine under Karl Wernicke
Founder of evolutionary/dynamic models (“Gestalt”)
“Abstract attitude”
“Catastrophic reaction”
While inspiring, his model has proved difficult to use

67. Hiatus in Aphasiology 1920-1960
1. Behaviorism and black box models
2. Increased focus on reductionist
sciences (e.g., biochemistry)
3. Psychoanalytic dominance
4. Legacy of holists; information processing models forgotten

68. Weisenberg & McBride (1935)
Re-examined Head’s clinical tests and found them lacking
Important advances in methodology (control groups, standardized scores, etc.)
Proposed an intuitive classification scheme: Receptive/expressive/ expressive-receptive/amnsesic

69. A.R. Luria
Traumatic Aphasia, WWII; role of motivation, attention, sensory feedback, language in control and regulation.
Modular elements, syndrome analysis
Double dissociation of functions
Qualitative assessment, neuropsychological tests (Luria-Nebraska Battery, 1974) which emphasized studying linguistic errors
Evolution of brain injury symptoms

70. Luria Influenced by Pavlov’s second signal system
“Constellation of cerebral zones” model
(psychological functions are not localized in a single location in the brain, but are distributed across a system of different modular subcomponents)
Efferent and afferent motor aphasia

71. Penfield & Roberts
Famous series of electrical cortical stimulation experiments in the 1960s
Used monopolar electrodes – now replicated in greater detail with bipolar electrodes

72. Cortical stimulation studies

73. Norman Geschwind
Veterans and Harvard Neurologic Unit of Boston City, later at Beth Israel.
Extended information-processing models
Parallel systems, alternative pathways
Close to anatomy and comparative anatomy

74. Hildred Schuell Key aphasia educator and clinician of the 1970s
Compassionate therapy – avoiding “catastrophic reaction”
However, key concepts were overly simple and not tested empirically…

75. Eric Lenneberg
“The biological foundations of language” (1967)
Motor correlates of language development
Plasticity in the face of early brain injury
- Equipotentiality
- Lateralization is an outcome of language learning
Limits on plasticity provide evidence for critical periods in language development

76. Roman Jakobson (1896-1982) Russian-American linguist
Reinvigorated linguistic approaches to understanding aphasia
Similarity vs. contiguity disorders
Suggested “Regression Hypothesis” (Child Language and Aphasia, 1971)
Inspired many current linguistic aphasiologists

77. Jakobson
“The varieties of aphasia [severe language disorder] are numerous and diverse, but all of them lie between the two polar types just described. Every form of aphasic disturbance consists in some impairment, more or less severe, either of the faculty for selection and substitution or for combination and contexture. The former affliction involves a deterioration of metalinguistic operations, while the latter damages the capacity for maintaining the hierarchy of linguistic units. The relation of similarity is suppressed in the former, the relation of contiguity in the latter type of aphasia. Metaphor is alien to the similarity disorder, and metonymy to the contiguity disorder.”

78. Harold Goodglass
Published articles on disorders of naming in aphasia, on category specific disorders of lexical comprehension and production, on the comprehension of syntax and on the syndrome of agrammatism.
Carried out a program of studies on cerebral dominance.
Collaborated with many clinicians and researchers, and in 1960 he developed a standardized aphasia test known as the Boston Diagnostic Aphasia Examination, which has been translated into many languages.
Author of over 130 research articles and four books.

79. Other modern contributors
Jerry Fodor
Noam Chomsky
Roger Sperry, Michael Gazzaniga
George Ojemann
Herman Kolk, Klaus Heeschen
PDP school: Jeffrey Elman, Gary Dell, Elizabeth Bates, Myrna Schwartz
Boston School: Harold Goodglass, Edith Kaplan, Sheila Blumstein, Alfonso Caramazza, Howard Gardner, Edgar Zurif

80. Jerry Fodor
Defends a strong version of faculty psychology, according to which the mind consists of informationally encapsulated, ‘low-level’ perceptual modules which feed information to ‘higher-level’ non-modular cognitive processes.
Only modular cognitive processes can be studied scientifically.
An ardent critic of connectionist models of cognitive phenomena, arguing that they cannot account for the rationality of thought.
According to Fodor, the neurological properties of the brain are irrelevant to its cognitive properties.

81. Horizontal and vertical faculties
Horizontal – A single faculty/psychological mechanism that underlies various cognitive domains (Fodor, 1983) – e.g., a single faculty of memory that is used for all types of memory. Similar to a faculty of “judgment”
Vertical –Faculty/mechanisms for specific domains. – e.g., memory for events, people, or objects.
According to Fodor, vertical modules have informational encapsulation, mandatory operation, domain specificity, and shallow outputs.

82. Boston school

83. The end