Wednesday, January 10, 2018

Reading :: Manual of Aphasia Therapy

Manual of Aphasia Therapy
By Nancy Helm-Estabrooks and Martin L. Albert

Here's another (old-ish) book on aphasia therapy. This book is now in its third edition, but I'm reviewing the first edition (1991), which is what UT had in its library.

This book is a good, solid introduction to aphasia rehabilitation, including the neuroanatomy of language, the neuropathology and classification of aphasia, diagnosis, therapy, and impact on family. I found it to be accessible even without any neuropsychology training.

In the first section, the authors break down different types of aphasia along with lesion location (p.21). Like most modern neuropsychologists, these authors caution not to assume that brain functions are localized, but they acknowledge that lesions in specific locations are associated with specific types of aphasia: for instance, Wernicke's aphasia is associated with lesions in the "Posterior third of superior temporal gyrus" (p.21). This means that, just by identifying specific language issues, the therapist can categorize the aphasia and identify where the lesion is without detecting it directly.

The authors go on:
... strong evidence now exists to support each of three apparently unconnected views of the neurology of language: (a) that elements of language can be related to highly focal cerebral centers, (b) that language is organized in the brain in a regional or zone-like pattern, and (c) that every language act involves networks of neurons widely distributed throughout the brain, functioning in series and parallel. (p.32)
They advocate accommodating all three views in a single model in which
multiple, complex overlapping neuronal systems most likely are involved in language processing. These neuronal networks include cortical and subcortical components, some of which are near each other, providing the basis for regional contributions to language, and some of which are more distant, providing the basis for widely distributed, parallel processing of aspects of language. All of the regional and widely distributed networks are multiply interconnected. (p.32)
In this view, the so-called "centers" of language are really "critical 'bottlenecks' for the processing of selected elements of language" (p.33). Notice how this conception seems to accord with Luria's general understanding of cognition as not strongly localized, although it perhaps goes farther away from localization than Luria did (as is common in modern neuropsychology). Overall, an interesting and revealing book. 

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