A MANUAL FOR RE-EDUCATION OF APHASIA PATIENTS A Project Presented to the Faculty of the School of Education The University of Southern California In Partial Fulfillment of the Requirements for the Degree Master of Science in Education by Maurice Sklar June 1950 UMI Number: EP46066 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation Publishing UMI EP46066 Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 £ A ’S O This project report, written under the direction of the candidate's adviser and approved by him, has been presented to and accepted by the Faculty of the School of Education in partial fulfillment of the requirements for the degree of Master of Sdence in Education. Date .............. £ „ Adviser Dean TABLE OF CONTENTS CHAPTER PAGE I. INTRODUCTION................... 1 Nature of the Problem................. 2 Neurological Implications ............. 3 II. NATURE OF A P H A S I A ....................... 8 The Specific Nature of Aphasia . . . . 9 Classification of Types of Aphasia . . 10 Description of the Classification . . . 11 III. DIAGNOSIS ........ .. . ............. 16 Case Histories............ 16 Psychological Testing.............. . 21 Evaluation of Testing ................. 31 IV. SPEECH THERAPY............................ 32 Retraining in Reading ................. bO Retraining in Writing ................. b2 V. LANGUAGE RETRAINING AND PHYSICAL MEDICINE REHABILITATION if 9 VI. SUMMARY AND CONCLUSIONS................. 58 BIBLIOGRAPHY . . . ............................ 62 APPENDIX .................................. . 6b Case S t u d y .................................. 6if Glossary . ................................ 101 CHAPTER I INTRODUCTION It has been estimated that there are over M-00,000 people in the United States today who are -unable to use language symbols because of brain damage. Each year about 20,000 additional people become disabled in a similar manner and this number is on the increase with the greater percentage in the population of those over fifty. Until recently, the neurological aspects of aphasia patients were concerned with a very extensive and minute neurological examination and the arrival at a diagnosis. Psychological investigations then focused the attention on personality and behavior disorders but the patients were relegated to a hospital bed and permitted to vegetate for ten, fifteen or twenty years until released by death. That the majority of patients can be rehabilitated to lead a fairly normal, useful life is a recent concept in medicine. Of these neurological patients, those suffer­ ing with aphasic manifestations are the most challenging to the therapist. In order for a therapist to approach the problem of treating aphasic patients, there are several areas of information necessary for a complete orientation., He should be acquainted with the neurological implications, the psychological tools that can be used in determining personality aberrations and the therapeutic methods that have been used successfully. In order to help these patients achieve a maximum amount of economic and social adjustment, a well integrated program of physical medicine rehabilitation is necessary. The speech therapists in the aphasia clinic spearhead the rehabilitation program and for them, as well as others interested in aphasia therapy, this .project is intended. NATURE OF THE PROBLEM If we should suddenly be deprived of the ability to speak, read, write or in any way express our needs, pains or aspirations, we would be in the predicament of the person afflicted by a cerebro-vascular-aceident. The soft gray mass of tissue inside the cranium which assumes the controlling influence of intelligence is disrupted from its accustomed function and the individual is sudden­ ly thrown back to a lower level of human functioning. The brain is the organ of consciousness, of ideation and voluntary muscular control, receiving impressions necessary to life, such as respiration and circulation. Any damage to any part of the brain reflects itself in the altered reaction of the individual to himself and to his environ­ ment. 3 Neurological Implications. Brain tissue is very delicate and may be injured by disease or accident. One of the most common causes of brain damage, especially o among older people, is the bursting of a blood vessel in the brain, called a "stroke". Another type of damage z, frequently occuring in the brain is an embolism or blood clot in one of the blood vessels feeding the brain. A 3 third type of injury may be caused by a tumor which also acts like an embolism by creating pressure and disturbing or destroying the functions of the adjacent areas. The f brain may also be damage by physical accidents which cut 5- or tear parts of the delicate tissues. Infection or disease is another cause of possible damage to the brain. All these organic changes in the brain cause corresponding changes in total personality functioning depending upon the degree and severity of the damage. During the process of learning, people favor the development of one side of their bodies. In most people the right side of the body is-stronger than the left. side. The brain is likewise divided into two distinct hemi­ spheres. The right hemisphere controls the left side of the body and the left hemisphere controls the right side of the body. The person who uses his left hand for writing, throwing, etc. has developed a dominance in the if right hemisphere of the brain. The right handed person develops cerebral dominance in the left hemisphere. When the dominant hemisphere of the brain is injured, aphasia usually results and the extent of damage determines the type and degree of dysfunction. The brain acts as a control tower or switchboard for all physiological, emotional, psychological and intellectual functions. The three major communication lines controlled are: 1. Sensory nerves: Lines reporting sensation from all the sense organs of the body such as ear, eye, nose, skin, etc. and viscera organs such as stomach, heart, etc. 2. Motor nerves: Lines originating in the brain, extending to all the muscles to control and stimulate them for bodily activity. 3. Association nerves: Lines solely within the brain to correlate and integrate the functions of the different sections of the brain. Although the nervous system is divided into three distinct parts, it is well to remember that they are mutually dependent and cooperative. The central nervous system which comprises the brain and spinal cord, serves to correlate and integrate the various parts of the body to make them work as a good team. The peripheral nervous system con­ tains the nerve fibers that pass from the receptors, to the central nervous system, to muscles and glands. The autonomic nervous system controls the unconscious actions of the visceral organs such as chest, abdomen and glandular tissue. The nervous system reacts at three levels of com­ plexity. The spinal cord contains switching centers that make simple acts possible. The brain-stem which is in part a continuation of the spinal cord controls the more complex behavior patterns. The cerebral cortex controls complex behavior such as learning, thinking and conscious exper­ ience. Connections between the elements of the nervous systems appear in three different ways. We are born with certain connections already functioning. Others become functional through a process of maturation independent of learning. The complex connections become functional only through a process of learning and adaptation. An important aspect of the nervous system to consider in retraining is that many duplicate pathways are provided for the simplest stimulus response act. Often the duplicate connections lie side by side but there are many instances in which the duplicate nerve path takes quite a different course from the receptor of the sense organ to the effect­ ors. This is biologically advantageous since injury 6 resulting in loss of function is greatly reduced by the possibility of compensation. Injuries to the brain need not bring permanent disability since the brain is especially rich in duplications which may be fertile for training to assist or take over the impaired function. The nervous system provides a means for the formation of new connections between receptors and effectors. When specific items of motor or sensory behavior become modified or exaggerated due to brain lesion it can be inferred that the damaged area is solely responsible for the behavior in question. The electrical currents employed- to stimulate the brain can to some extent help us' localize the areas of the brain that dominate specific activity. The use of drugs applied directly to cortical tissue can also be used to destroy or exaggerate certain types of responses. The doctrine of Johannes Mueller states that a given sensory nerve will produce a certain type of experience no matter how it is stimulated. The sensation produced depends upon the nerve cells that have been stimulated and not upon the stimulus applied. When the area of the cortex immediately in front of the fissure of Rolando is stimulated some voluntary muscles respond. The long motor neurons lead down from this area through the spinal cord to the muscles of the body and extremities. Any damage to this area of the brain produces an impairment