Wednesday, January 10, 2018

Reading :: Aphasia and Related Neurogenic Language Disorders

Aphasia and Related Neurogenic Language Disorders (Third Edition)
Edited by Leonard L. LaPointe

This collection overviews different kinds of aphasia (e.g., Broca's, Wernicke's) and related disorders (dementia, traumatic brain injury) as well as related issues (functional neuroimaging; social and life approaches to intervention; pragmatics). The scope is large, but less focused on diagnosis and therapy than other aphasia books I've recently read. I won't treat the book exhaustively, but I'll pull out some interesting parts from the chapters.

The book starts with LaPointe's chapter "Foundations: Adaptation, accommodation, and Aristos," which describes how people acquire aphasia, what it is, and how people react to it. Crucially, LaPointe says (quoting MacKenzie Buck), aphasia is a "family disease": some argue that "the social context, especially the family, must be an integral part of the condition" (p.5). Drawing on Morse and Johnson's 1991 ethnography, LaPointe describes stages in the illness experience (p.7), including the family and identity dynamics at play in diagnosing, compensating for, and accepting aphasia (pp.8-11).

Along these lines, in her chapter "Social and Life Participation Approaches to Aphasia Intervention," Roberta J. Elman overviews the work on social approaches in the 1980s and 1990s, quoting an earlier LaPointe publication to argue that we need a "sociology of aphasia" (p.41). One practical approach is the "life participation approach to aphasia (LPAA)," in which "all those affected by aphasia are entitled to service" and "advocacy efforts should be targeted to those components that are not available in our current healthcare system" (p.41). She adds, "a social approach to treatment requires that each individual's language impairment be viewed within the context of the individual's entire life" and includes attempts to "incorporate the daily activities and life participation events of that individual into the treatment plan from the very beginning" (p.43).

In Chapter 4, "Language and Discourse Deficits Following Prefrontal Cortex Damage," Carol Frattali and Jordan Grafman discuss the anatomy of the prefrontal regions and how damage to these regions can be associated with deficits. They extensively quote Luria's (1970) Traumatic Aphasia, noting that according to Luria,
the special position of language in the organization of behavior is compromised following PFC damage. Accordingly, the prefrontal syndrome is caused largely by disruption of the regulatory role of language on general behavior (Luria, 1970; Luria & Homskaya, 1964). Behavior, in Luria's view, suffers from a lack of the internalized linguistic schema that normally precede and guide any purposeful action and depend on the integrity of the prefrontal cortex. Translated in daily life terms, patients know what they should do and can verbalize it, but cannot always do as they should. Therefore, there is a dissociation of word and deed. This notion suggests that language is impaired not at a strict linguistic level but at a cognitive level of complex, goal-directed and intentionally regulated behavior. (p.55)
The above is consistent with Luria's agreement with Vygotsky's claims about how humans use symbolic tools to master themselves. But, the authors note, "a growing corpus of neuroimaging and lesion studies is beginning to weaken the above claims as being all-inclusive of the nature of language disturbances following PFD damage" (p.55).

This is the fourth book in a row that I've reviewed on aphasia, and I keep describing these books with the term "accessible." Although this collection is not written for a general audience, I found it (mostly) easy to follow, and I learned a lot about how aphasia and related disorders appear and function. As the above quote suggests, this work also has helped me to understand Vygotsky and Luria in different ways. Overall, I recommend this book.

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