Common errors in English aphasic discourse

The study involved documentary videos of 40 English-speaking patients. The overall video length is 180 minutes. The recordings can be freely accessed on YouTube channels of healthcare institutions (i.e., County Durham & Darlington NHS Foundation Trust, Flint Rehab, Tactus Therapy) and individuals (Sarah Scott channel and the like) who share their rehabilitation process after strokes, etc. The inclusion criterion was aphasia of any type in adulthood. The dominating type of discourse was personal narration combined with answering questions of an interviewer. The documented discourse underwent linguistic analysis (language-in-use descriptive approach) according to the following criteria: intelligibility, coherence, cohesion, grammatical structure of utterances, prosody and intonation, thus combining formalist (or structuralist) and functionalist research paradigms that proved to be effective for aphasic discourse analysis (Armstrong, 2000).

To ensure quality analysis of aphasic discourse a range of factors that influence rehabilitation success should be taken into account: the type of brain damage, location and type of lesion, age and overall physical state of a patient. In less severe cases, when cerebral blood supply is impaired for a short period of time, patients may regain their ability to communicate in hours or days. However, in the majority of cases it takes much longer to regain former ability to communicate. The process may last weeks or months after the trauma. Furthermore, there are severe cases that require a lot of treatment time. Even so, symptoms of aphasia may still remain. The most common errors typical of aphasic speech are word retrieval errors, errors at the phonological, grammatical and syntactical levels (Kutasi, 2017).

Results and Discussion

The speech is intelligible, cohesive and coherent. The narration is well- structured: introduction, the main part and conclusion. However, the speech is very slow, yet clear and rather well articulated. The sentences are short and simple, all the members of the sentences are put in the correct order, no errors, e.g., I have stroke. I have aphasia. Complex and compound sentences are sometimes challenging for her: My friend no go how to talk to me instead of My friends don't know how to talk to me. The vocabulary that is used in the narration seems to be easily retrieved, however there are few articulatory mistakes (tongue slips): ['peis] - ['peiks], [tips] - [sip]. Sentence stress is correct, notional parts of speech are stressed whereas functional are not. The intonation of the utterances is normal, even though the speech tempo is slower than such of an average language user who does not suffer from aphasia.

The research has shown less successful examples of speech production (Broca's Aphasia). When asked about their previous health condition (Now tell me what this thing was with your legs last week or week before), one of the patients with aphasia utters No good. Egg and knees and ankles instead of leg and knees... This case illustrates articulatory error, they use nominal structures only, even though the patient seems to understand the question. The pauses between words are rather long (10 - 20 seconds), so the speech rhythm is impaired.

For some patients with aphasia answering interview questions is easier than narration. Robert, in his fifties, is answering two interview questions (Aphasia: A loss of words, not thoughts):

Question 1: What does aphasia mean to you?

Answer: It affects me both in understanding what people say and also in speaking. I have to really concentrate when somebody is speaking to me. I get very bothered by other noises and distractions. I have trouble kind of putting the different words together and finding words that put the entire sentence together at times. And then sometimes it can flow okay.

Question 2: What are some day-to-day problems that aphasia has caused for you?

Answer: So I have trouble with giving instructions, placing orders, my biggest problem is dealing with doctors, dealing with a question and answer session. Not like we are doing here, because you've given me something written [interview questions] to help as well.

Robert's speech is cohesive and coherent, his answers are detailed, the sentence structure is extended and grammatically correct, there are both nominal and verbal phrases. The vocabulary is varied and suitable. The speaker admits he has problems with concentration, but even this factor does not deteriorate his speech function.

Another example of an interview with an elderly aphasia patient who has a stroke Fluent (Aphasia. Tactus Therapy). Byron Peterson (BP) is having a conversation with his doctor, Megan Sutton (MS).

MS: Hi Byron! How are you?

BP: I'm happy. Are you pretty? You look good. The utterance seems to be cohesive (syntactic structure is normal), but incoherent. The speaker articulates sounds well, there are no errors.

MS: And what were we just doing with the iPad?

BP: Uhh...right at the moment they don't show the damn thing. Ha-ha!

Bryan's answer demonstrates that he does not understand the syntactic structure of the question. He might not understand the context of the question, too. He must have recognized the word iPad, not paying attention to the tense form used by the interviewer. Moreover, the patient used incorrect tense in the reply (they don't show, not they are not showing).

MS: With the iPad, what were we doing? Like here?

BP: I'd like my change for me and change hands for me. It would happy.

The syntactic structure the patient uses is incorrect, the listener might be confused. Articulation and speech tempo are normal. The utterance is neither cohesive, nor coherent.

BP: I would talk with Donna sometimes. We're out with them. Other people are working with them and them. I'm very happy with them. This girl was very good. And happy and I play golf and hit up trees. We play out with the hands. We save a lot of hands on hold for peoples, for us. Other hands. I don't know what you get, but I talk with a lot of hand for him.”

In this extract we observe excessive use of deictic pronouns (them), the listener will not understand who Bryan refers to. Moreover, the patient uses a lexical unit hand in many structures; this might cause illocutionary silencing, the sense is not relevant for the listener.

The examples of aphasic discourse demonstrate various degrees of intelligibility and coherence. This does not always depend on age of a patient, rather on type of aphasia and rehabilitation process itself.

The typical syntactic errors that the patients with aphasia made, were the following:

1) omitting functional parts of speech (articles, prepositions) and pronouns, e.g. So, [I] have a stroke three years ago;

2) misuse of pronouns: a) I [my] first half marathon was two years ago; b) Sometime I [my] grammar is not really good, sometimes you 're okay;

3) prevalence of nouns and adjectives in sentences: Um...home...dizzy...lay- headed...fall ...friend...call

911... ambulance...doctor... stroke... right... side... left-hemisphere...

The articulation of the patients is mainly characterized by omission of consonants in words, i.e., patients pronounce vowels only, and mixing phonemes in words (the so-called “spoonerisms” [tips] - [sip]).

Table 1 shows common errors in aphasic discourse of the 40 patients whose narratives were analyzed in this article. The “+” sign shows presence of a certain type of error.

Table 1

Common errors in aphasic discourse

The results of the study show that in the participants with aphasia three types of error prevail. These are syntactic and articulatory errors (55% and 50% of all the participants respectively, made mistakes when speaking) alongside with low coherence (the speech of 75% patients is incoherent). Moreover, 37.5% of the patients spoke rather slowly that prevented listeners from following the speaker. It must be noted that this speech characteristic does not depend on a patient's a ge: younger and older people with aphasia exhibited this. The lexical errors occurred in 37.5% of all the cases (the same ratio as for slow speech): the patients struggled to pick the correct word and/or misused words. The speakers also substituted one word by another belonging to the same semantic group (arm - leg, week - month). Notably, the percentage of people who spoke slowly and who suffered with choosing the correct words coincides. This demonstrates the tendency that problems with lexical level lead to change in speech rate.

Conclusions

Aphasia: A loss of words, not thoughts. Retrieved from https://tinyurl.com/zazyszvc Broca's Aphasia. Retrieved from https://tinyurl.com/2f8y49d7 Fluent Aphasia. Tactus Therapy. Retrieved from https://tinyurl.com/2p8n967m Young Stroke Survivors with Aphasia. Retrieved from https://tinyurl.com/2dehnh7s

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