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Forgotten cases of bilingual aphasics
BRAIN
AND
LANGUAGE
15,
92-94 (1982)
Forgotten Cases of Bilingual Aphasics KURT KRAETSCHMER University
of Nebraska
at Omaha
This paper attempts to complement M. Paradis’ (1977, In Studies in neuroNew York: Academic Press. Vol. 3) and M. Albert and L. Obler’s (1978, The bilingual brain. New York: Academic Press) surveys of polyglot aphasics by describing two cases reported by C. Durieu (1969, La r&ducation des aphasi@es. Brussels: Dessart). linguistics.
During recent years, Paradis (1977) and Albert and Obler (1978) provided surveys of polyglot aphasics without mentioning two cases reported by Durieu (1969). The first case reported by Durieu is that of a 43-year-old Spaniard living in France. He was admitted to the hospital following an infectious inflammation and thrombosis of the left internal carotid artery. Eleven months subsequent to the episode, the patient was admitted to the rehabilitation center where a right hemiplegia with aphasia (total loss of oral expression) was diagnosed: “Hemiplegie droite avec aphasie (perte totale de la parole articulee)” (Durieu, 1969, p. 144). The case report revealed that the patient was right-handed, and had spoken French since adolescence. He came to France at the time of the Spanish revolution, and was of Protestant religion, Born in 1915, he was married to a Spanish woman and the couple had six children. He studied law until his emigration to France. At the beginning of the rehabilitation program, the patient explained everything by gestures without pronouncing a single word. Stereotyped utterances were extremely frequent (“6 . . . C . . . CbCbC . . .“). The language test (the Head Test) showed that the bilingual subject (Spanish and French) suffered from a slight right hemiplegia (vascular origin), and a predominantly expressive aphasia coupled with an almost total anarthria. His articulated speech was strictly limited to stereotyped syllables which were without any communicative value (“oh! la, la, lala!“). During The author is grateful to Dr. Laurence Hilton for his assistance with the manuscript. Address correspondence to Dr. Kurt Kraetschmer, Department of Foreign Languages, Box 688, University of Nebraska, Omaha NB 68182. 92 0093-934X/82/010092-03$02.00/0 Copyright All rights
0 1982 by Academic Press. Inc. of reproduction in any form reserved.
FORGOTTEN
CASES
OF
BlLlNGUAL
APHASIA
93
the 11 months following the episode, not the least amelioration had occurred. The therapy program encompassed three 3-month periods as an inpatient and three periods as an outpatient (1, 2, and 8 months) with therapeutic sessions three or four times a week. After the second outpatient experience, it was noted that the patient spoke much better Spanish than French: “Suivant les dires de sa femme il parle beaucoup mieux en espagnol et retrouve, spontanement, bien des mots de sa langue maternelle” (Durieu, 1969, p. 161). At the end of the rehabilitation program, the patient had regained sufficient language proficiency to engage in professional activities as a blue collar worker and to establish social contacts in an environment in which he was obligated to use a foreign language. What is noteworthy in this case, therefore, is the possibility of rehabilitation outside the mother tongue: “. . . une reeducation a Cte possible en dehors de la langue maternelle” (Durieu, 1969, p. 166). The second case reported by Durieu is that of a 59-year-old Catholic priest, holding a doctorate in theology and thus presumably competent in Latin and Greek, with rudimentary knowledge of Biblical Hebrew. The patient had used Latin in performing ritual ceremonies and probably also during the course of his ecclesiastical duties. He presumably had used Greek for Scripture readings of the New Testament and Hebrew for the study of the Old Testament. When the patient was admitted to the hospital, the medical examination revealed a right hemiplegia with an aphasia of vascular origin (probably atherosclerotic plaque): “Hemiplegie droite avec aphasie, d’origine vasculaire (plaque d’atherome vraisemblable)” (Durieu, 1969, p. 195). Two and a half months after the onset of aphasia, the patient was admitted to the rehabilitation center. The first test (the Head Test) revealed that the patient’s chief impairment was in the area of word finding. His articulation (oral expression), although very deficient overall, was seen to be successful on the first attempt for the repetition of some two-syllable words. The ability for written expression was totally lost. After only three stays (2 months, 3 months, and 3 months) over a period of 2 years at the rehabilitation center, the Head Test revealed the following improvements (in percentage) when compared with the first test taken at the beginning of therapy. Task Pointing or execution Naming Repetition Reading aloud Accuracy Comprehension Pointing or execution Copying
Improvement of tasks upon oral command
of tasks upon written command
(%) 12.45 57.00 100.00 58.82 70.45 16.33 100.00
94
KURT KRAETSCHMER
Writing to dictation Expository writing Movements in mirror
4.56 7.69 26.00
At the end of three additional stays as an inpatient (2 months, 2 months, and 2; months) over a period of 2 years, and 3 years as an outpatient from June 1964 to July 1965, the patient’s rehabilitation program was terminated. At this time, his spontaneous speech was still limited and characterized by single key words as well as incomplete sentences which were reduced, generally, to subject and verb. However, the answers to questions were less and less slow. Reading aloud was still halting; prepositions and articles were often omitted, the verb was sometimes replaced by a homonym, but self-corrections were frequent. On the activity level, the patient was now able to carry out all necessary everyday functions. Above all, what was probably one of the most essential accomplishments for him, he had regained the ability to celebrate daily mass. Interestingly enough, he used Latin which, according to Durieu, facilitated the reminiscence of old speech automatisms: “11 celbbre la messe tous les matins dans la chapelle de sa residence. Nous avons pu assister a l’une de ces premieres messes. Elle Ctait dite en latin, ce qui facilite les reminiscences d’automatismes anciens . . .” (Durieu, 1969, p. 215). Although the description of these two bilingual aphasics provided by Durieu is not exhaustive enough to shed new light on the phenomenon of bilingualism and aphasia, the two cases should not be omitted in future surveys of bilingual and polyglot aphasics. The second case might be pertinent to theories regarding the so-called automaticity factor which appears in prayers (Schwalbe, 1920; Balint, 1923) and other automatized linguistic material, such as songs (Keith & Aronson, 1975; Sparks, Helm & Albert, 1974). The first case might give support to the theory that a language different from that used in therapy may recover as well (Fredman, 1975). REFERENCES Albert, M., & Obler, L. 1978. The bilingual brain. New York: Academic Press. Balint, A. 1923. Bemerkungen zu einem Falle von polyglotter Aphasie. Zeitschrift ftir die gesamte
Neurologie
und Psychiatric,
83, 277-283.
Durieu, C. 1969. La rC&ducation des aphasiques. Brussels: Dessart. Fredman, M. 1975. The effect of therapy given in Hebrew on the home language of the bilingual or polyglot adult aphasic in Israel. British Journal of Disorders of Communication, 10, 61-69. Keith, R., & Aronson, A. 1975. Singing as therapy for apraxia of speech and aphasia: Report of a case. Brain and Language, 2, 483-488. Paradis, M. 1977. Bilingualism and aphasia. In H. Whitaker and H. A. Whitaker (Eds.), Studies in neurolinguistics. New York: Academic Press. Vol. 3. Schwalbe, J. 1920. Uber die Aphasie bei Polyglotten. Neurologisches Zentralblatt, 39, 265. Sparks, R., Helm, N., & Albert, M. 1974. Aphasia rehabilitation resulting from melodic intonation therapy. Cortex, 10, 303-316.
AND
LANGUAGE
15,
92-94 (1982)
Forgotten Cases of Bilingual Aphasics KURT KRAETSCHMER University
of Nebraska
at Omaha
This paper attempts to complement M. Paradis’ (1977, In Studies in neuroNew York: Academic Press. Vol. 3) and M. Albert and L. Obler’s (1978, The bilingual brain. New York: Academic Press) surveys of polyglot aphasics by describing two cases reported by C. Durieu (1969, La r&ducation des aphasi@es. Brussels: Dessart). linguistics.
During recent years, Paradis (1977) and Albert and Obler (1978) provided surveys of polyglot aphasics without mentioning two cases reported by Durieu (1969). The first case reported by Durieu is that of a 43-year-old Spaniard living in France. He was admitted to the hospital following an infectious inflammation and thrombosis of the left internal carotid artery. Eleven months subsequent to the episode, the patient was admitted to the rehabilitation center where a right hemiplegia with aphasia (total loss of oral expression) was diagnosed: “Hemiplegie droite avec aphasie (perte totale de la parole articulee)” (Durieu, 1969, p. 144). The case report revealed that the patient was right-handed, and had spoken French since adolescence. He came to France at the time of the Spanish revolution, and was of Protestant religion, Born in 1915, he was married to a Spanish woman and the couple had six children. He studied law until his emigration to France. At the beginning of the rehabilitation program, the patient explained everything by gestures without pronouncing a single word. Stereotyped utterances were extremely frequent (“6 . . . C . . . CbCbC . . .“). The language test (the Head Test) showed that the bilingual subject (Spanish and French) suffered from a slight right hemiplegia (vascular origin), and a predominantly expressive aphasia coupled with an almost total anarthria. His articulated speech was strictly limited to stereotyped syllables which were without any communicative value (“oh! la, la, lala!“). During The author is grateful to Dr. Laurence Hilton for his assistance with the manuscript. Address correspondence to Dr. Kurt Kraetschmer, Department of Foreign Languages, Box 688, University of Nebraska, Omaha NB 68182. 92 0093-934X/82/010092-03$02.00/0 Copyright All rights
0 1982 by Academic Press. Inc. of reproduction in any form reserved.
FORGOTTEN
CASES
OF
BlLlNGUAL
APHASIA
93
the 11 months following the episode, not the least amelioration had occurred. The therapy program encompassed three 3-month periods as an inpatient and three periods as an outpatient (1, 2, and 8 months) with therapeutic sessions three or four times a week. After the second outpatient experience, it was noted that the patient spoke much better Spanish than French: “Suivant les dires de sa femme il parle beaucoup mieux en espagnol et retrouve, spontanement, bien des mots de sa langue maternelle” (Durieu, 1969, p. 161). At the end of the rehabilitation program, the patient had regained sufficient language proficiency to engage in professional activities as a blue collar worker and to establish social contacts in an environment in which he was obligated to use a foreign language. What is noteworthy in this case, therefore, is the possibility of rehabilitation outside the mother tongue: “. . . une reeducation a Cte possible en dehors de la langue maternelle” (Durieu, 1969, p. 166). The second case reported by Durieu is that of a 59-year-old Catholic priest, holding a doctorate in theology and thus presumably competent in Latin and Greek, with rudimentary knowledge of Biblical Hebrew. The patient had used Latin in performing ritual ceremonies and probably also during the course of his ecclesiastical duties. He presumably had used Greek for Scripture readings of the New Testament and Hebrew for the study of the Old Testament. When the patient was admitted to the hospital, the medical examination revealed a right hemiplegia with an aphasia of vascular origin (probably atherosclerotic plaque): “Hemiplegie droite avec aphasie, d’origine vasculaire (plaque d’atherome vraisemblable)” (Durieu, 1969, p. 195). Two and a half months after the onset of aphasia, the patient was admitted to the rehabilitation center. The first test (the Head Test) revealed that the patient’s chief impairment was in the area of word finding. His articulation (oral expression), although very deficient overall, was seen to be successful on the first attempt for the repetition of some two-syllable words. The ability for written expression was totally lost. After only three stays (2 months, 3 months, and 3 months) over a period of 2 years at the rehabilitation center, the Head Test revealed the following improvements (in percentage) when compared with the first test taken at the beginning of therapy. Task Pointing or execution Naming Repetition Reading aloud Accuracy Comprehension Pointing or execution Copying
Improvement of tasks upon oral command
of tasks upon written command
(%) 12.45 57.00 100.00 58.82 70.45 16.33 100.00
94
KURT KRAETSCHMER
Writing to dictation Expository writing Movements in mirror
4.56 7.69 26.00
At the end of three additional stays as an inpatient (2 months, 2 months, and 2; months) over a period of 2 years, and 3 years as an outpatient from June 1964 to July 1965, the patient’s rehabilitation program was terminated. At this time, his spontaneous speech was still limited and characterized by single key words as well as incomplete sentences which were reduced, generally, to subject and verb. However, the answers to questions were less and less slow. Reading aloud was still halting; prepositions and articles were often omitted, the verb was sometimes replaced by a homonym, but self-corrections were frequent. On the activity level, the patient was now able to carry out all necessary everyday functions. Above all, what was probably one of the most essential accomplishments for him, he had regained the ability to celebrate daily mass. Interestingly enough, he used Latin which, according to Durieu, facilitated the reminiscence of old speech automatisms: “11 celbbre la messe tous les matins dans la chapelle de sa residence. Nous avons pu assister a l’une de ces premieres messes. Elle Ctait dite en latin, ce qui facilite les reminiscences d’automatismes anciens . . .” (Durieu, 1969, p. 215). Although the description of these two bilingual aphasics provided by Durieu is not exhaustive enough to shed new light on the phenomenon of bilingualism and aphasia, the two cases should not be omitted in future surveys of bilingual and polyglot aphasics. The second case might be pertinent to theories regarding the so-called automaticity factor which appears in prayers (Schwalbe, 1920; Balint, 1923) and other automatized linguistic material, such as songs (Keith & Aronson, 1975; Sparks, Helm & Albert, 1974). The first case might give support to the theory that a language different from that used in therapy may recover as well (Fredman, 1975). REFERENCES Albert, M., & Obler, L. 1978. The bilingual brain. New York: Academic Press. Balint, A. 1923. Bemerkungen zu einem Falle von polyglotter Aphasie. Zeitschrift ftir die gesamte
Neurologie
und Psychiatric,
83, 277-283.
Durieu, C. 1969. La rC&ducation des aphasiques. Brussels: Dessart. Fredman, M. 1975. The effect of therapy given in Hebrew on the home language of the bilingual or polyglot adult aphasic in Israel. British Journal of Disorders of Communication, 10, 61-69. Keith, R., & Aronson, A. 1975. Singing as therapy for apraxia of speech and aphasia: Report of a case. Brain and Language, 2, 483-488. Paradis, M. 1977. Bilingualism and aphasia. In H. Whitaker and H. A. Whitaker (Eds.), Studies in neurolinguistics. New York: Academic Press. Vol. 3. Schwalbe, J. 1920. Uber die Aphasie bei Polyglotten. Neurologisches Zentralblatt, 39, 265. Sparks, R., Helm, N., & Albert, M. 1974. Aphasia rehabilitation resulting from melodic intonation therapy. Cortex, 10, 303-316.