Making sense of the maze: Exploring the source of neologistic errors in a case of jargon aphasia

1. Making sense of the maze: Exploring the source of neologistic errors in a case of jargon aphasia Melanie Moses1,2,3, Lyndsey Nickels2, Christine Sheard3 Royal Rehabilitation Centre Sydney1, Macquarie Centre for Cognitive Science, Macquarie University2, The University of Sydney3

2. Neologisms • Typify language in jargon aphasia • Disagreement re definition and source • Different definitions: • any nonword response (e.g Miller and Ellis, 1987) • unrelated to target Vs phonologically-related (e.g. Buckingham, 1987; Schwartz, et al., 1994)

3. This presentation…. • Neologism = nonword responses that are unrelated to target. e.g. ball  dEb • Non-word responses phonologically related to the target = phonological errors. e.g. ball  bIl

4. Case Study: KVH • 71-year-old-man • Left basal ganglia (CVA) in January 2000 • Severe fluent jargon aphasia. • Wernickes  Conduction Aphasia • Fluent spontaneous speech with ++ perseverative, neologistic & semantic jargon • Good comprehension at basic conversational level but difficulties at complex level

5. Aims • Determine KVH’s language processing breakdown • Determine the source of KVH’s neologisms

6. Speech X Mild impairment Auditory analysis Acoustic-to-phonological conversion Phonological Input Buffer X Mild impairment Phonological Input Lexicon X But many phonologically-related errors • can process some phonological information Phonological Output Lexicon Phonological Output Buffer Phonological encoding Speech

7. Pictures, seen objects Speech Print Auditory analysis Visual feature analysis Acoustic-to-phonological conversion Abstract Letter Identification Phonological Input Buffer Visual Object Recognition System X Orthographic Input Lexicon Phonological Input Lexicon Conceptual Semantics X X Lexical Semantics Moderate central semantic deficit

8. Pictures, seen objects Print Visual feature analysis Abstract Letter Identification Severely impaired access to phonological form via lexical reading route X Orthographic Input Lexicon X X Lexical Semantics Letter-sound rules X X Phonological Output Lexicon Phonological Output Buffer More phonologically-related responses to nonwords & regular words  some intact sublexical processing Phonological encoding Speech

9. Research Tasks • Picture naming, word reading aloud, word repetition • 126 items, presented twice • Repetition: • few errors, mainly phonological (real & nonword) • mild phonological encoding difficulties • few neologisms • Naming & Reading Aloud: • many errors  50% neologistic • large proportion of phonological errors in reading reflects • impaired phonological encoding • imageability effect in naming (Wald = 4.818; p = .028) • semantic impairment.

10. Where is KVH’s language breaking down?

11. Pictures, seen objects Speech Print Auditory analysis Visual feature analysis Acoustic-to-phonological conversion Abstract Letter Identification Phonological Input Buffer Visual Object Recognition System Orthographic Input Lexicon Phonological Input Lexicon Conceptual Semantics Lexical Semantics Letter-sound rules Phonological Output Lexicon Orthographic Output Lexicon Phonological Output Buffer Graphemic Output Buffer Sound-Letter Rules Phonological encoding Speech Writing

12. Where do KVH’s neologisms come from? Let’s first look at the literature…….

13. Impaired self-monitoring? • Poor self-awareness of speech errors in jargon aphasia (Marshall et al., 1998)  more susceptible to neologisms • Poor self-monitoring linked with poor auditory comprehension (Ellis et al., 1983) although this is debatable (Nickels & Howard, 1995)

14. Can impaired self-monitoring account for KVH’s neologisms? • Superior self-monitoring in repetition (least errors, few neologisms): • proportionately more errors rejected (Vs. naming or reading) • more likely to reject error than correct response • largest proportion of “don’t know” responses • presence of phonological model in repetition to compare intended with actual response?

15. But….. • In repetition: • just as likely to reattempt a correct as error response and unable to successfully self-correct errors. • reattempted only 20% of errors, only 1 resulting in correct response • In picture naming: • many neologisms • significantly more error than correct responses reattempted  more accurate self-monitoring than repetition?  Relationship between neologisms & self-monitoring not straightforward KVH’s neologisms can’t be explained in terms of poor self-monitoring alone.

16. Impaired phonological encoding? • Neologisms reflect severe distortion of a target at phonological encoding level  response contains no target-related phonemes? (e.g. Kertesz & Benson, 1970) • Phonological distortion of an error from an earlier stage of lexical access (e.g. Nickels, 2001) (semantic error  phonological error)

17. Can impaired phonological encoding account for KVH’s neologisms? • Could account for the source of some of KVH’s neologisms BUT... • he should have produced large numbers of neologisms in repetition as phonological encoding is common to all 3 tasks • absence of syllable length effects in any task  primary source of KVH’s neologisms is NOT phonological encoding impairment

18. Underlying lexical access impairment? • Neologisms fill in a “lexical” gap when word selection fails (Buckingham & Kertesz, 1976; Butterworth, 1979, 1992). • Butterworth (1979, 1992) proposed “KC” used back-up “device” which generates neologisms after failure to retrieve lexical target. • neologisms generated by random assembly of previously produced phonemes – ie. perseveration • Obeyed English phonotactic rules  • Didn’t obey English phoneme frequency x = no underlying lexical target?

19. Butterworth (1979, 1992) • Neologistic errors reflected failed attempt to retrieve the target word at lexical level  default to a neologism-generating “device.” • Phonemic variants of a “device” neologism may be used up to 5 or 6 times  string of phonologically similar neologistic responses. • Example: bklnd – bndIks – ndIks – zndIks – lndIks – zprIks • These phonologically-related neologisms are well documented in jargon aphasia

20. Can impaired lexical access account for KVH’s neologisms? • Neologisms may result from severe impairment in accessing the lexical form of the word. • Naming = SS  POL X • Reading aloud = OIL  SS  POL X • Phonological encoding deficits further impact on performance • Can access sublexical phonological information in repetition • Unable to derive sublexical phonological information from written input

21. Therefore... • insufficient activation of target lexical representation  phonemes from previous responses assembled to form a neologism. • neologism fills the lexical “slot” for the missing target (Butterworth, 1979; 1992)  KVH’s neologisms could reflect an underlying impairment accessing the lexical form of the word via both spoken or written modalities.

22. Perseverative influence on neologisms • Majority of KVH’s neologistic errors in all tasks were perseverative (Repetition: 67%; Reading: 83%; Naming 64%). • Suggests production of neologisms strongly linked to a process of perseveration

23. KVH’s perseverative error patterns • KVH mainly produced phoneme perseverations in all tasks • But different types in Repetition Vs Picture Naming & Reading Aloud

24. Repetition • Nail  n1l • Star st1l Short duration, phonologically related to target

25. Neologistic perseverative strings • Picture naming: • psn  pIs  pIs  pIsn  frn pI (bowl) (glasses) (carrot) (desk) (cannon) • Reading aloud: • sibr sig sua  sup  sug (zebra) (chain) (apple) (carrot) (mountain) Long duration, unrelated to target Consistent with neologistic strings in literature on jargon aphasia

26. KVH’s perseverative errors • KVH’s perseverative errors reflect his different levels of processing breakdown, (phonological encoding in repetition, lexical access in reading aloud and picture naming) • Consistent with recent research on perseveration (Cohen & Dehaene, 1998, Martin et al., 1998, Moses et al 2004, Hirsh, 1998)

27. Conclusions • KVH’s neologisms most likely reflect impaired activation of phonological forms via the semantic system • Consistent with some research (e.g. Butterworth, 1979, 1992; Simmons and Buckingham, 1992) • Contradicts others proposing neologisms reflect severe underlying phonological encoding difficulties alone (e.g. Kertesz and Benson, 1970; Lecours and Lhermitte, 1969) • KVH’s neologisms typical of jargon aphasia • Errors are consistent with Butterworth’s (1979, 1992) neologism generator theory • Strong link between KVH’s production of neologisms and phoneme perseveration

28. Future Directions • Investigate alternative accounts for production of neologisms e.g. substitution of phonemes based on phoneme frequency (Butterworth, 1992) • More detailed discussion of nature of KVH’s perseverative errors and links with neologisms • Replication across series of individuals with jargon aphasia

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