Production of narrative and procedural discourse in aphasia

BRAIN

AND

13, 345-371 (1981)

LANGUAGE

Production

of Narrative and Procedural in Aphasia

Discourse

HANNA K. ULATOWSKA University

of Texas at Dallas

ALVIN J. NORTH University

of Texas Health

Science

Center

at Dallas

AND SARA MACALUSO-HAYNES University

of Texas at Dallas

The study described the abilities of a group of 10 aphasics and 10 normals to produce narrative and procedural discourse. The experimental tasks included telling stories, producing summaries, giving morals to the stories, and producing procedures. The variables examined in the investigation included features of sentential grammars, such as amount of embedding, and features of discourse grammars, such as occurrence of elements of superstructure in narrative. Additionally, raters assessed the content and clarity of the discourses. The results showed that aphasics produced well-structured narrative and procedural discourse. Aphasics’ discourse errors differed only in degree, not qualitatively, from those of normals. The language of the aphasics’ discourses was reduced in both complexity and amount. It was found that the aphasics had difficulties in producing summaries and giving morals for the stories when compared with the normals. Both the content and clarity of the discourses produced by the aphasics were rated lower than those produced by the normals. The authors wish to thank graduate assistants Gina Conti, Christie Seltzer, Alice Doyel, and Jayne Larson for their assistance in data analysis; and speech pathologists Erin May, Beverly Morshed, Helen Ludwig, Bemice Paul, and Josephine Simonson for their help in selecting patients for this investigation. Special thanks to Beverly H. Hildebrand for her assistance in testing the patients; to Temple Baker for statistical analysis of the data; and to Renee Freedman-Stem for the editorial help on the earlier versions of this paper. Correspondence should be addressed to: Hanna K. Ulatowska, University of Texas at Dallas/ Callier Center for Communication Disorders, 1966 Inwood Road, Dallas, Texas 75235. 345 0093-934X/81/040345-27/$02.00/0 Copyright All rights

0 1981 by Academic Press, Inc. of reproduction in any form reserved.

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INTRODUCTION

Recent years have witnessed a major expansion of scope in the study of language from the investigation of simple sentences to the study of connected speech, i.e., discourse. There are several reasons for this major shift. Discourse studies address problems of the social, psychological, and pragmatic aspects of communication, as well as its linguistic aspects. In the social aspect, discourse involves language as speaker-listener exchange within a particular communicative context. Studies in this area enable us to investigate speakers’ knowledge of the contextual use of language as compared to their knowledge of purely linguistic rules, in other words their communicative competence. Over the last few years, a number of studies in the field of aphasiology addressed the question of the communicative competence of aphasics. The question became relevant with a need for scientific verification of clinical impressions of a discrepancy between aphasics’ performance on standardized tests and their communicative functioning in natural environments. The use of contextual information was hypothesized as the primary variable accounting for the difference. Holland (1977) produced the first clinical tool (CADL) to measure this type of communicative performance in aphasia. Ulatowska, Haynes, Hildebrand, and Richardson (1977) attempted a qualitative analysis of communicative behavior in aphasia in the framework of accompanying context. These investigations found that some severely impaired aphasics were extremely functional since they tapped the entire spectrum of communicative devices. Holland (1975), Ulatowska et al. (1977), and McCurdy (1978) reported that speech acts such as agreeing, promising, and complaining, which constitute communicative assets of aphasic patients, could be enhanced by utilizing more natural communicative settings. Along the same line Wilcox and Davis (1977) demonstrated that aphasics’ contextual comprehension abilities with indirect requests were superior to their receptive performance on standardized comprehension tests. Another study by Stachowiak et al. (1978) reported that aphasics were not impaired in text comprehension as compared to isolated sentences on a text-picture matching task because they successfully utilized the context and redundancy of texts. Psychological studies of discourse consider the roles of memory, attention, perception, and other mental processes in discourse. The primary psychological issue addressed is the relationship among cognition, the organization of human knowledge, and language. Coherence is the key factor in investigations of this relationship. Many discourse studies have investigated the coherence and cohesion of texts and their relation to thought (Halliday & Hassan, 1976; Longacre, 1976; van Dijk, 1977). Both coherence and cohesion relate to the well-formedness of

PRODUCTION OF DISCOURSE IN APHASIA

347

text: coherence, in terms of the plausibility, conventionality and conclusiveness of text, is a general cognitive concept, while cohesion refers to linguistic devices such as anaphora and reference, which produce coherence. Labov and Fanshel(1977) provided a comprehensive methodology for a thorough analysis of levels of coherence in the narratives of therapeutic interviews, which were regarded simultaneously as a diagnostic device and the method of therapy. Rochester, Martin, and Thruston (1977a) and Rochester, Thruston, and Rupp analyzed samples of thought-disordered speech and non-thought-disordered speech by evaluating the coherence of discourse. Their results indicated that though schizophrenic speakers used fewer cohesive devices than normals, the thought-disordered speakers were not, in general, incoherent. In another study (Freedman-Stern, 1978), analysis of the discourse of a patient with the diagnosis of acute confusional state revealed disruption of coherence and cohesion despite complete preservation of syntactic and textual structure at a sentence level. Opposite results were reported in a study of the written language of a Wernicke’s aphasic (Ulatowska & Freedman-Stern, 1978), in that the coherence of the discourse structure was preserved through proper utilization of cohesive devices, in the presence of a severe disruption of linguistic structure at a sentence level. Another type of disassociation phenomenon was described by Luria (1976), in patients with lesions of the anterior zones of the speech area in the left hemisphere. These patients exhibited a marked disturbance of spontaneous narrative speech that disassociated it from all other aspects of language which remained intact. The defect was particularly noticeable in the production of discourse on a topic specified by the experimenter. In a recent study by Huber (1978), the effect of coherence on production of linguistic and nonlinguistic (pictorial) narratives was investigated in a group of left- and right-hemisphere patients. Narratives with low and high cohesion were developed experimentally to be manipulated by the patients. The preliminary reports of the study indicate that aphasics did not have more difficulties with the pictorial narratives than the righthemisphere patients, and that the degrees of cohesion in text did not affect the performance of the subjects in either group. Linguistic studies of discourse concentrate on the following tasks: 1. defining the formal and structural characteristics of discourse grammar, such as the form of rules, types of units, and formal ways of incorporating into the grammar information of an extralinguistic nature. 2. defining the rules of well-formedness of discourse and the nature of cohesion in discourse. 3. describing different types of discourse. Several studies have attempted to characterize the language features of discourses of special populations. Berko-Gleason and Goodglass (1977),

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in a study of the production of narrative discourse by two groups of Broca’s and Wernicke’s patients, reported reduction in the number of themes and in the amount of embedding in the aphasic groups as compared to normals, and marked differences in style between Broca’s and Wernicke’s aphasics. In a study that compared the production of isolated sentences and connected discourse in spoken and written language, Ulatowska, Hildebrand, and Haynes (1978) reported on differences between isolated sentences and discourse sentences in the two modalities in the length of clauses and the amount of embedding. Along the same lines, Obler (1979) investigated the production of spoken and written discourse by elderly normal, demented, and Parkinson’s patients. She hypothesized that patterns of narrative discourse might evidence language change even though other linguistic skills such as vocabulary and comprehension remain stable. Her results were tentative. PURPOSE

The purpose of this investigation was to study the ability of a group of mildly impaired aphasics to produce discourse. Two types of discourse were chosen for the investigation: narrative and procedural. Until recently, nearly all studies of aphasic language have dealt with the production of isolated sentences. This research would contribute to a characterization of discourse in aphasia and to an efficient methodology for eliciting various discourse genres and forms. We selected a population of mildly impaired aphasics since they are capable of producing an amount and variety of language adequate for the purpose of studying discourse structure and the patterns of its disruption. We chose a narrative form of discourse because it exhibits the most discernable and the most extensively studied internal organization (Labov, 1972; Longacre, 1976; Grimes, 1977; van Dijk, 1977; Kintsch, 1977). We chose to study procedural discourse primarily because it consists of language which is very simple syntactically and which is more constrained to temporal order than narrative discourse. Because of the simplicity of its language and its internal organization, it is conspicuously different from the narrative discourse, and therefore, might be differentially impaired in aphasia. SUBJECTS

Ten aphasic subjects were selected for the investigation, eight males and two females between the ages of 54 and 70. The etiology of the aphasia in every case was a single cerebrovascular accident in the left hemisphere. Six patients exhibited a right hemiplegia. Following initial speech and language evaluation, language impairment of one patient was diagnosed as mild, four as mild to moderate, and five as moderate to severe. At the time of experimental testing, which on the average was 23.6 months postonset, three subjects were described as mild to moderate,

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PRODUCTION OF DISCOURSE IN APHASIA

while seven were only mildly aphasic. Based on available neurological data, initial speech and language evaluation, and the administration of standardized language tests for this investigation, two patients were classified as having anterior lesions, four as posterior, and four as mixed. A control group of 10 subjects was matched to the experimental population in age, sex, and education. Table 1 shows the descriptive data for the two groups. MATERIALS

AND METHODS

The diagnostic battery administered to the aphasic population consisted of the following tests: I. Standardized tests to evaluate language functioning: A. Selected subtests of the Boston Diagnostic Aphasia Examination and B. Part V of The Token Test. II. Standardized tests to evaluate cognitive functioning: A. The Knox Cube Test was administered as a measure of both attending ability and short-term/immediate memory. Both abilities are necessary to perform optimally on the experimental portion of the investigation, since subjects must attend to and remember information about current tasks and prior instructions. B. The Associate Learning Test from The Wechsler Memory Scale was used to assess verbal learning and short-term memory for verbal materials. C. The Block Design and Picture Arrangement subtests of the WAIS were included as measures of nonverbal cognitive ability. The Block Design Subtest is a problemsolving task and requires the use of effective strategies for its correct solution. The Picture Arrangement Subtest requires the subject to find a meaningful order in a set of pictures. Since the narratives and procedures used in this study have a similar ordinal character, the subtest appeared useful. III. Experimental tests designed to elicit verbal discourse: A. Narrative Discourse 1. A self-generated account of a memorable experience. 2. A “cat” story elicited with the help of sequence pictures, 3. The retelling ofa “rooster” story immediately following the examiner’s reading of the story. 4. A summary and a moral supplied by the subjects for the “cat” story and the “rooster” story. B. Procedural Discourse elicited with the help of sequence pictures. (The pictures were used to facilitate understanding of the nature of the task by providing a visual prop. The pictures were withdrawn from the subject prior to his stating the task.) 1. Brushing teeth, combing hair, cutting bread, and making sandwiches-routine procedures which are learned early and performed frequently. TABLE 1 DESCRIPTION

OF POPULATIONS

Aphasics N = 10

Normals N = 10

Measure

Mean

Range

Mean

Range

Age (Years) Education (Years) Months postonset

60.2 13.4 23.6

54-70 lo-18 6-103

58.7 14.4

54-7 1 12-20 -

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2. Bowling and changing a tire-procedures learned through special instruction and perhaps never performed. The sequence pictures used as stimuli for the “cat” story are shown in Fig. 1. The “rooster” story as read by the examiner is included below. Rooster Story Two roosters were fighting over the chicken yard. The one who was defeated hid himself in the corner. The other rooster flew to the top of the roost and began crowing and flapping his wings to boast of his victory. Suddenly, an eagle swooped down, grabbed the rooster and carried him away. This was good luck for the defeated rooster. Now he could rule over the roost and have all the hens that he desired. The tests were administered in three 45-min sessions in the subjects’ homes by two speech pathologists and a psychologist. All tests with the exception of the Boston Diagnostic Aphasia Examination and The Token Test were administered to the control group.

LINGUISTIC

FRAMEWORK

OF THE STUDY

In this section we will give a brief explanation of some concepts of discourse grammar relevant to the understanding of the present study. Discourse, like isolated sentences, conforms to statable rules. A narrative discourse is a language representation of a happening, real or imagined, which consists of matching a verbal sequence of clauses to the sequence of events which actually occurred. Narrative discourse is characteristically in either first or third person. The clauses of a narrative are typically ordered in temporal sequence. A fully formed narrative consists of an episode with the following structure: 1. Abstract (What was it about?) 2. Setting involving time and location, background, and identification of participants (Who, When, What, Where?) 3. Complicating action involving events (Then what happened?) 4. Evaluation (So what?) cat story

FIGURE

1.

PRODUCTION

OF DISCOURSE

IN APHASIA

351

5. Result or resolution (What finally happened?) 6. Coda (What is the moral?) The above order is conventional; however, variants can occur. Narrative can consist of more than one episode. Narrative structure is primarily motivated by the pragmatic knowledge that underlies the organization of experience. The experience has organization in the sense that events are related to each other in terms of a small set of time, causality, and association types, and the roles of participants are identified. Procedural discourse tells us how something is done. It consists of steps or procedures which are stated in specifiable order, and which are either conceptually or chronologically linked. Procedural discourse is goal oriented since the focus is on telling how something is done, not on who does it or on what is done, as in narratives. Procedural discourse may contain introducer, resolution, and coda. It can also include evaluation, though this would be much less frequent than in narrative. Expository discourse is primarily subject-matter oriented. It shows logical cohesion among all topics contributing to its specific subject matter. Unlike narrative and procedure, it does not have to have person reference or chronological sequence. DATA ANALYSIS

All discourse data elicited were tape-recorded and then transcribed verbatim. Written reports of gestural communication accompanying speech were noted in procedural discourse. The accuracy of the transcriptions was verified by two persons. Subsequently, the transcribed data were prepared for analysis by removing false starts and repetition. Due to the difficulty of identifying sentence boundaries in connected speech, the T-unit was adopted as the basic unit for segmenting the discourses. A priori, a T-unit is defined as one independent clause plus any dependent modifiers of that clause (Hunt, 1965). The variables examined in this investigation included features of sentential grammars and features of discourse grammars proper. Variables dealing with sentential characteristics included the following: 1. Length of T-units as measured in mean number of words. 2. Complexity of language as measured by: a. amount of embedding (expressed in number of clauses per T-unit); b. ratio of coordinate to subordinate conjunctions; c. percentage that dependent clauses are of total clauses; d. percentage that nonfinite clauses are of total clauses. Variables pertaining to discourse grammar consisted of: 1. Length of discourse type as measured by number of T-units. 2. Occurrence of elements of superstructure in narratives (e.g. setting, resolution) and in procedures (e.g. procedural steps).

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3. Length of elements of narrative superstructure as measured by number of T-units. 4. Amount of evaluation in narratives and procedures as measured by number of clauses containing evaluation. 5. Amount of adverbial modification in procedures as measured by number of adverbial phrases. In addition to the above objective analysis, a rating system was devised to evaluate the content and clarity of the discourses produced. We tentatively identified rating of content as a rough measure of the coherence of discourse, and we used rating of clarity as a rough estimate of the cohesion of discourse. Six audio cassettes were prepared, each containing all subjects’ responses to a different task, i.e., cat story and summary, rooster story and summary, memorable experience, and three out of the six procedures. The discourse samples of the aphasic and control subjects were randomized. Subjects were identified by number only. Five doctoral students in the Program in Communication Disorders were chosen to do the rating. None of them were familiar with the subjects. The conceptual distinction between the content and clarity of language was explained to them. They were told that a story can be evaluated “high” with regard to content but may contain unclear language or vice versa. Content of the discourses was rated, depending on the task, either on a two-point scale or on a three-point scale according to specific questions which were asked about the information contained in the task. The final score was derived through adding scores on individual questions. The questions are included in Appendix 2. Clarity of language was rated on a three-point scale: l-not at all clear; 2-not completely clear; and 3-completely clear. RESULTS Standardized

Language

Tests

The language profiles obtained from selected subtests of the Boston Diagnostic Aphasia Examination and The Token Test, Part V as seen in Table 2, characterized the population in the following way: 1. Severity ratings ranged from three to five; (rating scale: 0 = severe impairment, 5 = minimum impairment), two patients obtained a rating of 5, five patients a rating of 4 and three patients a rating of 3. 2. Eight of the ten aphasics obtained very high overall scores on the Boston, with only two patients falling below a 90% correct performance. 3. All subjects displayed high auditory comprehension scores on the three relevant subtests of the Boston-Word Discrimination, Commands, and Complex Material, and on Part V of The Token Test. 4. All aphasics evidenced some degree of naming deficit reflected in reduced scores on the Visual Confrontation Naming and Animal Naming

353

PRODUCTION OF DISCOURSE IN APHASIA TABLE 2 APHASICS’ PERFORMANCE ON STANDARDIZED LANGUAGE TESTS

Test

Possible points

Mean

Range

SD

5 277 99 178 105 19 21

3.9 243.3 95.3 148.0 95.5 11.5 15.3

3-5 175-268 88-99 77-174 43-105 7-16 7-21

0.74 27.37 3.47 27.21 18.99 3.27 4.67

Severity rating Boston total score Auditory comprehension Oral expression Visual confrontation naming Animal naming Token Test Part V

Subtests of the Boston. Reduction of naming ability was especially evident in the scores of two patients. 5. Oral expression scores were high for all aphasics except the two previously mentioned patients. Deficits in Oral Expression were manifested by both motor speech disorders and naming errors. Cognitive

Tasks

Table 3 describes the performance of the aphasic and normal subjects on the three cognitive tests which were used in this study. As may be seen from the ranges, each group was quite heterogeneous in ability, and there was substantial overlap between groups in the distributions of scores on the several tests. Even so, there were statistically significant differences in favor of the normals on the Block Design (both raw score and median time per task) and on the easy Associate Learning items. Linguistic Overall Performance

on Narrative

Tasks

and Procedural

Discourses

Table 4 summarizes the performance of aphasics as compared to normals on the production of narrative and procedural discourse. Narrative discourse (a composite score) subsumes all three narrative tasks, i.e., the cat story and summary, the rooster story and summary, and the memorable experience, whereas procedural discourse (another composite score) includes the six different procedures. The table indicates the following facts: in both narrative and procedural discourse there was a reduction in the complexity of the language in aphasics as shown in fewer words per T-unit and less embedding, which was manifested in fewer dependent and nonfinite clauses. This reduction of complexity was much more pronounced in narratives than in procedures. Aphasics preserved the difference between procedural and narrative discourse exhibited by normals in employing simpler language in their procedures. Aphasics produced less language as measured by number of clauses in both narrative tasks and procedures.

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ULATOWSKA,

NORTH, AND MACALUSO-HAYNES TABLE 3

PERFORMANCE

ON COGNITIVE

TESTS

Aphasics Test Knox cube Block design Points Time Picture arrangement Points Time Associate learning Easy Hard Total

Mean

Range

SD

12.2

9-14

25.2 39.1

Normals Mean

Range

1.99

13.4

9-17

2.17

1.29

4-37 15-60

11.18 19.59

35.9 16.5

14-48 9-60

10.77 15.41

2.18* 2.87*

18.9 41.4

12-30 22-60

6.90 14.06

23.5 30.3

6-35 14-51

8.03 14.51

1.37 1.74

13.6 4.1 10.9

8-18 o-12 4.5-19.5

3.34 3.72 4.51

16.7 5.8 14.1

15-18 I-10 9-19

1.06 3.33 3.72

2.80** 1.08 1.76

SD

t

* p < .05. ** p < .Ol.

TABLE 4 COMPARISON

OF APHASICS AND NORMALS ON SELECTED MEASURES DERIVED ANALYSIS OF NARRATIVE AND PROCEDURAL DISCOURSE

Aphasics

FROM

Normals

X

SD

X

SD

t ratio

Number of clauses

Narrative Procedural

56.9 55.0

13.4 21.3

80.4 95.4

30.9 51.2

2.49* 2.31*

Number of T-unit

Narrative Procedural

35.2 43.8

9.0 16.3

35.3 63.0

13.2 23.6

0.02 2.12*

Words per T-unit

Narrative Procedural

9.6 7.5

2.3 1.1

14.2 9.9

2.5 2.4

4.29** 2.81**

Clauses per T-unit

Narrative Procedural

1.7 1.2

0.4

2.4

0.1

1.5

0.4 0.3

4.13** 2.35*

% Dependent clauses

Narrative Procedural

31.9 15.7

12.5 8.9

46.4 21.6

10.7 9.9

2.80** 1.41

% Nonfinite clauses

Narrative Procedural

8.8 3.6

4.7 4.1

16.4 7.6

5.1 3.9

3.48** 2.24*

* p < .05. ** p < .Ol.

PRODUCTION OF DISCOURSE IN APHASIA

355

Narratives

Tasks involving the cat story and the rooster story produced no differences in language characteristics. Therefore, we have collapsed them together and will refer to them as one category. The elicitation of a memorable experience yielded two different types of discourses, narrative discourse proper and expository discourse; therefore, memorable experiences will be considered separately from the cat and rooster narratives. Table 5 compares the performance of aphasic and normal subjects on the narrative tasks in terms of sentence-level variables. The descriptive statistics in the table reveal the following about the two groups: 1. Aphasics produced fewer clauses than normals on all tasks except for the rooster summary. 2. Aphasics and normals produced a comparable amount of language in terms of number of T-units except for summaries, where aphasics produced more T-units. 3. Aphasics produced shorter T-units and also less complex language in terms of embedding and percentage of dependent clauses. 4. Neither aphasics nor normals showed any significant difference in the syntactic characteristics of language among the different tasks. 5. Although the differences were not significant, aphasics produced, noticeably, the longest sentences and most complex language on the retelling of the rooster story as compared to all other tasks. Performance

on Cat and Rooster Stories

The analysis of aphasics’ performance on the stories revealed their preservation of the narrative superstructure as manifested by the following features: 1. All subjects’ narratives contained all the essential elements of the superstructure, i.e., settings, complicating events and resolutions. 2. Some narratives displayed introducers and codas, which are optional elements. 3. The length of each element of the superstructure as measured by number of T-units was not significantly different in aphasics as compared to normals (See Table 6). 4. All subjects’ narratives showed preservation of the chronological sequence of events. 5. Settings contained temporal, locative, and motivational aspects of the background. 6. All subjects’ narratives contained ah of the participants in the action. 7. All subjects’ narratives contained evaluations, which are considered a necessary condition of acceptable narrative. The amount of evaluation was significantly lower in aphasics as compared to normals (Aphasics 1 = 18%, Normals 1 = 33%).

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ULATOWSKA,

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COMPARISON DERIVED

OF APHASICS AND NORMALS ON SELECTED FROM ANALYSIS OF INDIVIDUAL NARRATIVE

LINGUISTIC MEASURES DISCOURSE TASKS

Aphasics Measure

x

Normals SD

X

SD

1

Number of Clauses Rooster story Cat story Memorable experience Rooster summary Cat summary

12.1 15.3 16.9 6.3 6.3

3.7 7.3 5.8 1.6 2.7

13.5 27.7 27.8 4.8 6.6

3.6 13.4 18.3 1.9 3.2

0.87 2.57* 1.80 1.97 0.19

Number of T-units Rooster story Cat story Memorable experience Rooster summary Cat summary

6.5 9.7 10.9 3.8 4.3

1.1 5.4 3.7 0.8 2.0

5.7 11.6 12.3 2.8 2.9

1.4 4.5 7.8 1.7 2.6

1.42 0.86 0.52 1.70 1.35

Words per T-unit Rooster story Cat story Memorable experience Rooster summary Cat summary

12.3 9.2 8.4 8.8 9.3

6.0 2.7 2.1 2.1 3.0

13.4 13.8 15.2 13.6 15.1

3.2 3.2 2.7 6.7 5.3

0.51 3.41** 6.27** 2.18* 3.02**

Clauses per T-unit Rooster story Cat story Memorable experience Rooster summary Cat summary

1.9 1.7 1.7 1.7 1.6

0.5 0.5 0.5 0.4 0.6

2.4 2.4 2.3 2.1 2.7

0.5 0.7 0.4 0.9 1.0

2.51* 2.60* 3.06** 1.20 3.14**

% Dependent clauses Rooster story Cat story Memorable experience Rooster summary Cat summary

43.3 32.2 34.2 21.4 28.3

15.2 19.9 19.3 19.6 24.2

51.8 44.6 56.5 38.5 40.8

19.6 22.8 9.7 23.5 35.0

1.08 1.30 3.27** 1.76 0.93

% Nonfinite clauses Rooster story Cat story Memorable experience Rooster summary Cat summary

1.9 13.8 4.4 7.9 15.9

1.3 3.3 1.6 3.3 5.0

9.9 22.2 9.4 10.4 30.2

5.3 2.3 2.2 4.5 6.0

1.47 2.07* 1.86 1.90 1.82

* p < .05. ** p < .Ol.

PRODUCTION

OF DISCOURSE

IN APHASIA

357

TABLE 6 MEAN PERCENTAGE OF T-UNITS IN EACH ELEMENT OF THE NARRATIVE SUPERSTRUCTURE Aphasics Elements of superstructure Setting Complicating action Resolution Note. Percentage for codas and introducers produced them.

23.6 60.0 12.6 were not calculated

Normals

25.6 55.0 14.7 since only four subjects

The analysis of the linguistic forms relevant to well-formedness of narrative structure yielded the following results: 1. No significant differences between aphasics and normals in the ratio of coordinate to subordinate conjunctions. 2. No significant difference in the syntactic form of the first mention of the participants in the actions, since both aphasics and normals produced a comparable range of determiners in the form of definite and indefinite articles and possessive pronouns and modifiers before the nominals. 3. Lower noun to pronoun ratio in aphasics. (Aphasics 1 = .98, Normals x = 1.61) 4. Higher number of indefinite words such as “get” and “decide” in aphasics. 5. Reduced number of adverbial clauses in aphasics (39% less than normals). 6. No significant difference in the distribution of adverbial clauses in relation to the main clause, the clauses following the main clause being more frequent in both aphasics and normals. Performance

on Summaries

Analysis of the performance of the aphasics on the summary tasks revealed that all produced a version of a summary. However, four of the aphasics merely retold the stories instead of producing proper summaries. Two of these retellings were of the same length as the original stories, whereas the other two were just slightly shortened. All of them contained inappropriate amounts of detail, such as instances of evaluation and reported speech (see Appendix 2). Analysis of the aphasics’ summaries in terms of the elements of the narrative superstructure they contained, showed that all summaries had settings and complicating actions, and 70% of them had resolutions. Control subjects had a similar percentage of resolutions. It is assumed that a proper summary should contain all or most of the elements of the

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superstructure. It should be noted that of the subjects who produced summaries without resolutions, only one aphasic and one control could also produce a moral to the stories. This finding indicates that these subjects had difficulties in interpreting the meaning of the stories. Aphasics produced longer summaries and more T-units per summary than normals (see Table 6). Sentence-level analysis of the summaries showed that aphasics produced much simpler language than the normals in terms of amount of embedding and percentage of dependent clauses and nonfinite clauses. The aphasics used more pronouns as compared to nouns than normals. They also used more deictic expressions such as up there, and generalized verbs such as get. Performance

on Morals

The task of telling a moral is largely cognitive since it requires isolating two elements of the narrative superstructure, the complicating action and the resolution, interpreting their meaning, and then generalizing that meaning to a broader context of events. Analysis of the aphasics’ performance on the moral tasks revealed two distinct types of responses, defined according to their content. One type was a moral or proverb which referred abstractly to the meaning of the story; for example, “You ought not to crow too quickly over your victories” and “A person should not go too far out on a limb without assessing the situation.” Inappropriate morals maintained abstractness, but drew an unrelated point from the story; for example, “Don’t bite off more than you can”; “Well, not to boast loud enough so that someone can hear you.” The second type of response was advice or a lesson which referred directly to the events of the story; for example, “She shouldn’t have called her father to have gotten the cat down in the first place. She should have called the fire department.” and “Don’t get up there in that tree.” The difference between these two types lies in the level of abstractness; the former being abstract, the latter concrete. It must be noted that the cat story differs from the rooster story in the difficulty of the moral-giving task. The rooster story is an Aesop fable and as such, was written specifically for depicting a moral, whereas the cat story is not built around any particular moral. No aphasic produced a moral on the cat story. One aphasic failed to respond while the other nine gave story-related advice or comment instead of a moral. In contrast, only two normals produced story-related responses. Seven normals gave proverbs, and one normal could not come up with any moral. In response to the rooster story, only two aphasics gave proverbs or morals, three could not see any moral, and the rest gave either storyrelated responses or inappropriate morals. In contrast, all of the normals gave proverbs except for one who could not see any moral in the story. It

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PRODUCTION OF DISCOURSE IN APHASIA

is important to note all aphasics’ responses were expressed in correct language. Performance

on Self-Generated

Discourse (Memorable

Experience)

In the self-generated discourse, aphasics again produced much less language and syntactically less complex language than normals (see Table 5). The reduction of complexity was not importantly different from that observed in the narratives and summaries. In terms of the form of discourse, aphasics produced three different types: narrative discourse proper, with all the elements of the superstructure (i.e., setting, complicating action, resolution) present; episodic narrative with temporally linked events but no complicating action or resolution; and expository discourse dealing with one topic and all the events related to it, and displaying thematic as opposed to chronological organization. Three aphasics produced narrative discourse proper, two episodic discourse and five expository discourse. The same three types of discourse were produced by the normals. Content analysis of the discourses indicated that all three types were well formed. The narrative discourses proper had all the elements of the superstructure, proper identification of participants, and proper chronological organization. The episodic narrative had the two latter features as required. The expository discourses showed appropriate thematic organization, consisting of three main elements: abstract, which in our task, stated what the memorable experience was; orientation, which gave events relevant to that experience; and evaluation, which expressed the attitude or emotion of the narrator to the experience. It was this last element, evaluation, that showed a sharp differentiation between the aphasics and the normals. Aphasics produced much less evaluation as compared to normals (19.4 and 53.8% of all T-units, respectively). Procedures

Quantitative analysis of the procedural discourses as seen in Table 7 showed reduction of both the amount and complexity of language in the procedures of aphasics. It should be noted that both aphasics and normals produced simpler language in procedures than in narratives. The qualitative analysis of the language of procedures includes the following measures: pronoun usage, distribution of tenses, linkage type, amount of adverbial specification and amount of evaluation. No significant difference was noticed in tense and mood distribution in that both aphasics and normals used a complete range of forms, i.e., present, present progressive, imperative, and the would form. Similarly analysis of linkage revealed no differences between the populations in that most of the T-units were juxtaposed without any conjunction. The connectors and and then were the most frequent when conjunction was used. No differ-

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TABLE

7

COMPARISONOF APHASICSAND NORMALS ON SELECTED LINGUISTIC MEASURES DERIVED FROM ANALYSIS OF PROCEDURAL DISCOURSE

Normals

Aphasics Measure

Number of clauses Number of T-units Words per T-unit Clauses per T-unit % Dependent clauses % Nonfinite clauses Number of essential steps Total number of steps

X

SD

X

SD

55.0 43.8 7.5 1.2 15.7 3.6 4.1 5.5

21.3 16.3 1.1 0.1 8.9 4.1 1.6 3.0

95.4 63.0 9.9 1.5 21.6 7.6 5.7 8.6

51.2 23.6 2.4 0.3 9.9 3.9 0.5 2.4

I 2.31* 2.12* 2.81** 2.35* 1.41 2.24* 3.04** 2.46*

* p < .05. ** p < .Ol.

ence was noticed in the pronoun forms with first- and second-person pronoun used with the nonimperative forms. The deletion of first-person singular was observed in the procedural steps following the initial step as a stylistic variant in both populations. Another variable studied was adverb specification. Aphasics produced less adverbial specification in the procedural steps as compared to normals. This was observed with both adverbs of manner, which were present in all six procedures, as well as with adverbs of place which occurred only in a subset of three, namely, on making a sandwich, bowling, and changing a tire. Finally, no difference in the amount of evaluative language was observed. In the analysis of the structural properties of procedures, two variables were taken in consideration: presence or absence of essential procedural steps within a given procedure (determined pragmatically), and number of procedural steps included. The set of essential steps for changing a tire include: jacking the car up, removing the nuts, taking the wheel off, fitting a new tire on, and putting the nuts back. Whereas only four aphasics produced all the necessary steps on the six procedures, seven normals included all of them, and the remaining three missed a step on one procedure only. Aphasics produced a smaller number of steps within each procedure (jr = 5.5 as compared to normals 1 = 8.6). This is especially evident in the cases where the complexity of the procedure to be described increases, e.g., changing a tire, where the mean number of steps is 7.5 for aphasics and 16.5 for normals. Finally, no difference between the populations was observed on the presence of such structural elements of the procedure as introducer or coda. Illustrations of procedures with identification of all the characteristics described above are included in Appendix 1.

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Discourse Errors

As has already been reported, on the whole, the well-formedness in discourse, both narrative and procedural, produced by aphasics was preserved. This well-formedness was manifested by preservation of narrative and procedural superstructure, proper identification of participants, and maintenance of the chronological sequence of events. In most cases, aphasics utilized linguistic devices necessary to achieve cohesion such as marking verb tenses in the narratives, marking definiteness of nominals, and signalling sequences by appropriate connectors. Since given the present state of discourse studies the question of the “acceptability” of discourse is not well defined and is confounded by a number of unresolved issues, only broad categories of deviations in discourse structure will be mentioned here. It is important to initially state that all the deviations which will be discussed below were found in the discourse of both aphasics and normals, that the differences between the populations in this respect were a matter of degree, and that not al the differences were statistically significant. The following deviations were identified: I. Errors iu tense shift Whereas normals tended to have one shift of tense within a given episode, aphasics had a greater variety of tenses within a comparable discourse chunk, e.g. (narrative), “the little girl was crying because the cat is in the tree. The dad will try to get the cat. But the cat and the father have an argument between them and the catjumped from the limb.” (Procedure) “Well I brush my hair first and thenfluffit where it should be. I had a little teasing until it does like I want.” 2. Errors of Anaphora Errors of anaphora fell into the following types: a. use of pronouns with no previous reference, e.g., “You slice through the loaf until if comes off the loaf.” b. use of pronouns with ambiguous reference (narrative) e.g., “Her father climbs tree to get the cat. He gets caught. The cat gets off the tree. The fireman comes to get him.” (Procedure) “I’d take the bun and hamburger and set if over the grill.” c. inappropriate shift of pronoun, e.g. (procedure), “Walk over to your stand. Pick up your ball. They make their approach.” (Note that the pronoun errors are reflected in the previously mentioned lower noun to pronoun ratio in aphasics.) d. inappropriate distribution of deictics-this error was evident especially in procedures, e.g., “I use salt. I take my hand. I take it out of the box. Put a lot in here “And you line it up with the 12 pins down there and you try to send the ball between the lead place here and there.” 3. Errors in use of connectors (Narrative) e.g., “The kitten jumped on the ground whereas the little girl was now left on the ground with the father who had caught his coattail on a limb of the tree. A fireman came to get him down whereas the little girl howled and shed many tears.” “I was happy when my baby was born. She will be 46 on her birthday, but we lived out in the country and had to have the man to come out there.”

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4. Errors in chronological sequence of events (Procedure) e.g., “. . or if you got a foreign car, you’ll be a jack in the frame, jack it up, remove the old tire, put the new one on, remove the nuts-generally be five.”

Content and Clarity Ratings We turn to the findings regarding content and clarity ratings. Table 8 presents estimates of the reliabilities of overall ratings of quality of content and clarity of language by type of discourse. The method for obtaining these estimates will be illustrated for ratings of quality of content in the case of procedural discourse. Each rater’s ratings of quality of content were summed over three procedures. Then the 10 pairwise correlations among the five raters were found. The table gives the median of these correlations as an estimate of reliability per rater (.57). Then the reliability of the average of five raters’ rating of quality of content was obtained using the Spear-man-Brown formula (.87). All of the remaining reliability estimates were determined in the same way. The table shows that reliabilities of the pooled ratings were acceptably high for purposes of further analysis. Reliabilities of the pooled ratings were about equally good for quality of content and clarity of language, and somewhat higher for procedural than for narrative discourse. Table 9 presents data for aphasics on the relationship of content and clarity ratings to scores on the two standardized language tests. The total score on the Boston was significantly and strongly associated with all ratings. Of the subtests of the Boston, Oral Expression appeared to have the strongest relationships with these ratings. While generally positive, the 7’s for the Token Test were nonsignificant. Table 10 presents findings on the relationship of discourse ratings to scores on the various standardized cognitive tests. Although scores on the Knox Cube Test and the Associate Learning Test appeared to have some relationships with discourse ratings, the findings do not have a clear pattern. Of the cognitive tests, Block Design and Picture Arrangement appeared to have the strongest (but by no means strong) relationships with ratings. Since these two tests are nonverbal, these results suggest TABLE 8 RELIABILITIES

OF RATINGS

OF CONTENT AND CLARITY DISCOURSE

Quality of content

Type of discourse Procedural Narrative

OF LANGUAGE

BY TYPE OF

Clarity of language

Median interrater correlation

SpearmanBrown reliability

Median interrater correlation

SpearmanBrown reliability

.57 .38

.87 .75

.56 .75

.86 .87

PRODUCTION

OF DISCOURSE TABLE

363

IN APHASIA

9

RELATION(KENDALL'ST) OFSCORESON STANDARDIZEDLANGUAGETESTSTOCONTENT AND CLARITY RATINGSOF DISCOURSEPRODUCEDBY APHASICS Procedural discourse

Narrative discourse Content

Test

52* 42 37 44 57* 26

Boston Diagnostic Aphasia Exam (total score) Auditory comprehension Visual confrontation naming Animal naming Oral expression Token Test

Clarity

Content

Clarity

70** 14 51* 39 75* 38

78+* 12 49* 38 80** 30

60* 26 45 33 64** 26

* p < .05. ** p < .Ol. TABLE

10

RELATION (KENDALL’S r) OF COGNITIVEVARIABLESTO CONTENT AND CLARITY RATINGS OF NARRATIVE AND PROCEDURALDISCOURSES Quality of content Aphasics Narrative discourse Knox cube Block design raw score MDN. sec. per design Picture arrangement raw score MDN. sec. per item Associate learning easy score hard score total score Procedural discourse Knox cube Block design raw score MDN. sec. per design Picture arrangement raw score MDN. sec. per item Associate learning easy score hard score total score * p < .05.

Normals

Clarity of language Aphasics

Normals

45

39

30

49*

47 -42

40 -54*

38 -19

50* -49*

47 -45

43 -29

35 -61*

39 -28

31 -05 25

33 46 40

15 -28 02

28

45

35

45 -17

44 -17

38 -26

38 -55*

35 -52*

26 -34

-15

23 -30 -05

08 28 23

28 -21 -09

-19 -30 -27

39 54* 50*

-15

10 15 15

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that within each group, cognitive differences played a part in both the content and clarity aspects of narrative and procedural discourse. Table 11 presents findings bearing on the relationship of content and clarity ratings to a number of linguistic measures. Both in narrative and procedural discourse, number of clauses appeared to be more strongly related to ratings in the case of aphasics than in the case of normals. A somewhat similar pattern of findings holds for mean number of words per T-unit. Perhaps this low language output of the more severely impaired aphasics accounts for these apparent differences in strength of relationship. The findings regarding number of T-units, nonfinite clauses, and dependent clauses had no clear pattern and are difficult to interpret. Aphasics who failed to include all essential steps in procedural discourse were rated as poorer with respect to the content, but not the clarity of their discourse. On the other hand, total number of steps appeared to have no relationship to ratings. DISCUSSION

AND CONCLUSIONS

In this final section we will attempt to summarize the main findings of this study, relate them to the previous findings in the literature dealing with aphasia and discourse, and indicate some possible areas for future research. TABLE 11 RELATION (KENDALL’ST) OF SELECTED LINGUISTIC MEASURES AND COGNITIVE VARIABLES TO CONTENT AND CLARITY RATINGS OF NARRATIVE AND PROCEDURAL DISCOURSES Quality

of content

Clarity

of language Normals

Aphasics

Normals

Aphasics

Narrative discourse Number of clauses Number of T-units Mean number of words per T-unit % of dependent clauses % of nonfinite clauses

54* -05 27 45 22

24 38 11 -6O* 38

54* 05 54* 36 45

28 47 00 -47 28

Procedural discourse Number of clauses Number of T-units Mean number of words per T-unit % of dependent clauses % of nonfinite clauses Number of essential steps Total number of steps

61* 55* 39 05 34 57* 20

02 07 -16 00 02 -17 -02

30 28 16 - 14 02 57* -07

-15 -19 -10 -27 -34 -53* -19

* p < .05.

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The study yielded a characterization of the abilities of mildly impaired aphasics to produce narrative and procedural discourse, which can be summarized as follows: The aphasics studied produced well-structured narrative and procedural discourse in terms of the observance of the rules of superstructure: they properly utilized cohesive devices for the identification of the participants in the action, the connection of events and procedural steps. To the best of our knowledge, this is the only study which looks at the taxonomy of discourse structure in a group of aphasics, and therefore, it is not known to what extent this finding can be generalized to aphasics with more severe disruption of language. The only other study which reported on preservation of discourse structure in written language (Ulatowska and Freedman-Stern, 1978), dealt with an aphasic with severe disruption of sentential grammar. It is important to note that no simplification of the superstructure was observed in terms of length of elements such as setting and resolution, as is the case in the narratives of young children, who devote a smaller proportion of their narratives to background information, e.g., setting of events (Kernan, 1977). Aphasics’ discourse errors differed only in degree, not qualitatively from those of normals. This finding provides another piece of evidence for the concept of a continuum from disrupted to normal linguistic performance. It should be noted that all of the discourse errors identified by us are also features of unplanned discourses of normal speakers, described in a recent article by Ochs (1979). Ochs finds verb tense errors, ambiguous reference and other errors instances of developmentally earlier communicative strategies which adults adopt in spontaneous unplanned discourse. One of the most powerful communicative strategies operating here is that in unplanned discourse, speakers rely on the immediate context to express propositions. The ability of aphasics in this study to utilize context in discourse production has been previously documented in other discourse tasks involving comprehension (Wilcox & Davis, 1977; Stachowiak, Huber, Peck, & Kerchensteiner, 1978). The aphasics studied produced language which was reduced in both complexity and quantity. Reduced complexity of language was manifested by less embedding, i.e., smaller percentage of dependent and nonfinite clauses. This finding confirms the results of the previously reported study by Berko-Gleason and Goodglass (1977). Reduced quantity of language had some interesting consequences for the structure of discourse. It led to what looks like a selective decrease in information content in both narratives and procedures. In narratives, it was the amount of evaluation which was primarily reduced by aphasics. This part of narrative structure plays a secondary role, primarily that of elaboration, to the other necessary elements of the narrative such as complicating action or resolution, and is the only substitutable element in the story.

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Thus, reduction of evaluation does not drastically affect the plot structure. Moreover, evaluation involves use of some complex syntactic devices such as comparatives, negatives, and modals. Labov (1972) documented the development of some of the evaluative devices, and found a regular and marked increase in use from preadolescents to adults. It is plausible therefore that this reduction of evaluation in aphasics is related to either its function (less important information) or form (more complex language) or a combination of both. In procedures, where the syntactic form of the language is much less complex than in narratives, reduction was primarily in the amount of language that was observed. This reduction led to procedures with a small number of steps. It is important to note that the reduction of steps involved essential steps as well as ancillary steps, and thus resulted in procedures of lower quality. Four aphasics produced summaries as opposed to a mere retelling of the stories. Their summaries were longer than those of normals and contained inappropriate amounts of detail. The experiments conducted by van Dijk and Kintsch (1978) on recalling and summarizing stories in normal adults and children indicated that the quality of produced summaries is determined by semantic macrostructures whose function is to reduce and organize information. A summary then, is taken as a discourse expressing the macrostructure of another discourse. Since macrostructures are quite complex cognitive structures, their operation is likely to be adversely affected in aphasics, leading to the difficulties in producing summaries in this study. Aphasics, on the whole, were unsuccessful in producing morals on the cat story and the rooster story. As was previously mentioned, this deficit was not related to a lack of the linguistic resources necessary to express the proverb. It is plausible that this inability is related to a welldocumented reduction of abstract attitude in aphasia. Since concrete story-related comments were produced in place of more abstract metaphoric responses, it could also be suggested that the inability to produce morals is related to changes in the system of macrostructures which often involve high levels of abstraction. More research is needed before any explanation of the above deficits can be given. The discourses produced by aphasics were rated lower in both content and clarity than those produced by normals. The ratings correlated positively with the total score on the Boston Diagnostic Aphasia Examination, with the strongest relationship to the score in Oral Expression. The ratings of both content and clarity correlated positively with the amount of language produced by aphasics on both discourses. In procedures, the ratings correlated with the presence of essential steps, and in narratives the clarity of language was correlated with percentage of dependent clauses. In adopting the system of ratings, we hoped to gain some insight into the nature of linguistic cohesion and coherence. In a rather simplified

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scheme, operationally we posited that the quality of content might correspond to the notion of coherence, whereas the clarity of language might depend on utilization of devices producing linguistic cohesion. We were particularly interested in the relationship between coherence and cohesion, namely, whether it is possible to have a preservation of the quality of content or coherence despite the disruption in the system of cohesion devices. One might speculate that the lower the level of cohesion, the more constraints are impressed on coherence. Consequently, discourses which show lower levels of cohesion will have to be produced with a maximum of coherence. On the other hand, those discourses which show high levels of cohesion might vary widely on coherence. In addition, because coherence and cohesion are not completely independent, discourses which show lower levels of cohesion will be rated lower on coherence. We also hypothesized that there should be some relationship between the objective measures of sentence or discourse structure, and the ratings of the scorer. Since, in the present study, the aphasics were rated lower than normals on both content and clarity, and since the sample was rather small, this issue must await further investigations. To conclude, the present study allowed us insight into the structure of two types of discourses, narrative and procedural, as produced by aphasics. It showed us once again the systematic nature of language change in aphasia; the complexity of language was reduced, while language relatively free of sentential and discourse errors was preserved. It is interesting to speculate whether this reduction of complexity was motivated by a communicative strategy of compensating for the loss of language. Encouraged by the findings of the present study and wiser methodologically in terms of the pros and cons of eliciting different discourse types, we are embarking on a new study of more severely impaired aphasics to find mechanisms underlying both the preservation and breakdown in discourse structure.

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APPENDIX

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AND MACALUSO-HAYNES

1: EXAMPLES OF DISCOURSES APHASICS AND NORMALS Narratives

Aphasics

PRODUCED

BY Normals

Little cat climbed up the tree. The owner climbed after the cat. The cat jumped down. The owner hung up. The fireman got the ladder and rescued the owner.

Cat Story

Well a little girl standing by a tree looking up the tree to a branch where her cat is sitting. She is crying and explaining it to her father. Father decides to help her. He climb the tree while the little girl watches and the little girl watches as the father goes out on a branch and the cat is hissing at him because normally when a cat gets up a tree why they’re always sort of afraid when they are out on a limb. And the father goes out to grab the cat and the cat jumps down and the father hangs himself by the back of his coat on a branch and the little girl starts crying all over again and she has to get a fireman to help get her father down.

The little girl had a cat up the tree. She gets her father to see if she can get him down. He gets hung up. The fireman has to get him down.

Cat Summary

The daddy tried to rescue the kitty. In the end the kitty was the one that got by easily. The dad got the rough end of it.

Cat Moral

1. A person shouldn’t go too far on a limb without assessing the situation. 2. Cat which can climb trees can also climb down.

The roosters were having a fight. The one’d got defeated over in the thing. The other one he was crowing. All of a sudden an eagle came and roughed him up. The other rooster got the hens.

Rooster Story

This story is about two roosters who engaged in a fight in the chicken yard. The one who was vanquished retreated to a corner to sulk. The victor climbed up to the top of the roost to flap his wings, crow, and boast of his victory. But while he was perched there, an eagle swooped down, and carried him away. This left the defeated rooster, the one who was lucky, because he was able to take care of all the hens without competition.

Two roosters were fighting; one whipped the other; the one that whipped the other got up on the roof and was crowing and shouting and a hawk came down and carried him off which, in turn, was very enchanting to the rooster that was left.

Rooster

At the end of a fight between two roosters, the victor was seized and carried away by an eagle, so that the vanquished became the final winner.

I. Not to climb the tree after the cat. 2. I think I’d let the fire department get him down in the first place.

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369

Don’t fight with a rooster.

Rooster Moral

If you do win a victory,

don’t crow about it.

It’s my brother-he was only 29 years old. I was with him. And he died of a heart attack. That’s the sad thing about it. And I couldn’t do nothing about it. I was little and he was only 29 years old. I had six brothers die. Five of them had heart attacks. And one had a stroke. And they never lived to be as old as I am. And I am 58.

Memorable Experience

I guess one of the most memorable days in my life was when my youngest son was first born-my oldest son. He used to get raisin bread near there a little bakery in Oak Cliff. There was a Frenchman that worked there as a baker. He was a little fellow with great big ears. And I remember I was driving home from the hospital. I was going Zang Blvd. in Oak Cliff. This was in 1953 and I had a box of cigars that I was going to take to the guys out at the office. I stopped at a red light, and the little baker was in the car next to me and he said: “Hey, how’s your wife?” And I said I just got a baby boy and I threw him a cigar. And he’s a funny looking little fellow. But he really had a look on his face that he was just as happy as I was that we had this little boy. And that was really a very memorable experience that storyvery fine.

Procedures I get the bred. I get the sandwich meat. And I start to get them together. And I’d have some pickles on the bread and the margarine. And I make the sandwich with all those things.

Making a Sandwich

First I would get the tunafish cold and remove it from the refrigerator. First I would boil two eggs and after they have been boiled then remove the tuna from the refrigerator and squash the eggs and mix with mayonnaise and mustard and sweet-pickle juice, add into the mayonnaise and then take two delicious pieces of bread, heaps tons of mayonnaise and then its finished.

I’d have to jack the thing up off the ground and take the lugs off with the lug wrench-four or five lugs. Then I’d take the spare tire out of the trunk-be sure its aired up-and put it on the car-and be sure to drop the tire at the service station.

Changing a Tire

I’d first notice that the tire was flat. I would go to my trunk and remove the lug wrench and the jack arrangement. I would then jack the car up slightly and remove the hubcap. And with the wheel still on the ground I would loosen the bolts. And then after I had loosened them I would raise the jack higher-raising the car up higher. So then I could take the lugs off and remove the wheel. And then I would take the spare tire out of the trunk and put it on the wheel and then slightly lower the car so that again the wheel was touching the ground, put the bolts back on and tighten them, then completely lower it, put the bad tire back in the trunk, and put the hubcap back on, put the lug wrench and the jack in the trunk and go on our way.

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APPENDIX 2: CONTENT RATING FORM scoring Cat StorylRooster Story 1. Do you know what is happening in the story? 2. Does the sequence of events make sense? 3. Is the story unambiguous as to what each of the participants did? 4. Is the story accurate in terms of the stimulus material? Cat SummarylRooster Summary 1. Is it a summary as distinct .from retelling of the story? 2. Is it complete in the sense that it does not omit any necessary information? 3. Is it accurate in terms of the stimulus material? Memorable Experience 1. Do you as a listener know what the subject is talking about? Procedures 1. Could you follow this procedure?

1 = no 2 = for the most part 3 = yes

1 = no 2 = yes

1 = no 2 = yes 1 = no 2 = with difficulty 3 = yes

REFERENCES Berko-Gleason, J., Goodglass, H., Green, E., Obler, L., Hyde, M., & Weintraub, S. 1977. Narrative strategies of aphasics and normals. Paper delivered at the 15th Annual Academy of Aphasia Meeting, Montreal. Freedman-Stem, R. 1978.Discourse in acute confusional state-A case study. Unpublished paper, University of Texas at Dallas. Grimes, J. 1975. The thread ofdiscourse. The Hague: Mouton. Halliday, M. A. K., & Hassan, R. 1976. Cohesion on English. London: Longman. Holland, A. L. 1975. Aphasics as communicators: A model and its implications. Paper presented at the American Speech and Hearing Association Convention. Holland, A. L. 1977.Estimations of aphasic patients’ communicative performance in daily life. Final Report submitted to National Institute of Health. Huber, W. 1978. Linguistics and non-linguistic processing of narratives in aphasia. Paper delivered at the 16th Annual Academy of Aphasia Meeting, Chicago. Hunt, K. W. 1%5. Grammatical structures written at three grade levels. Research Report No. 3. Champaign, IL: National Council of Teachers of English. Keman, K. 1977. Semantic and expressive elaboration in children’s narratives. In S. Ervin-Tripp & C. Mitchell-Keman (Eds.), Child discourse. New York: Academic Press. Kintsch, W. 1977. On comprehending stories. In M. A. Just & P. A. Carpenter (Eds.), Cognitive processes in comprehension. New York: Wiley. Labov, W. 1972. Language in the inner city. Philadelphia: Univ. of Pennsylvania Press. Labov, W., & Fanshel, D. 1977. Therapeutic discourse. New York: Academic Press. Longacre, R. 1976. An anatomy of speech notions. Lisse: The Peter de Ridder Press. Linde, C. 1975. Speech errors, error correction and the construction of discourse. Paper presented at NWAVE, Georgetown Univ. Press.

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Luria, A. 1976. Basic problems of neurolinguistics. The Hague: Mouton. McCurdy, P. 1978. Selected performative utterances in aphasic language. Unpublished doctoral dissertation. University of Texas at Dallas. Obler, L. 1979.Narrative discourse style in the elderly. Paper presented at Conference on Language and Communication in the Elderly, Boston. Ochs, E. 1979. Planned and unplanned discourse. In T. Givon (Ed.), Syntax and semantics, Vol. 12. New York: Academic Press. Rochester, S. R., Martin, J. R., & Thruston, S. 1977. Thought process disorder in schizophrenia: The listener’s task. Bruin and Language, 4, 95-114. (a) Rochester, S. R., Thruston, S., & Rupp, J. 1977.Hesitations as clues to failure in coherence: A study of the thought-disordered speaker. In S. Rosenberg (Ed.), Sentence production: Developments in research and theory. Hillsdale, NJ: Erlbaum. (b) Stachowiak, F. J., Huber, W., Poeck, K., & Kerschensteiner. 1977. Comprehension in aphasia. Bruin and Language, 4, 177- 195. Ulatowska, H. K., Haynes, S. M., Hildebrand, B. H., & Richardson, S. M. 1977. The aphasic individual: A speaker and a listener, not a patient. In R. H. Brookshire (Ed.), Clinical Aphasiology Conference Proceedings. Minneapolis: BKR Publishers. Pp. 198-213. Ulatowska, H. K., Hildebrand, B. H., & Haynes, S. M. 1978.A comparison of written and spoken language in aphasia. In R. H. Brookshire (Ed.), Clinical Aphasiology Conference Proceedings. Minneapolis: BRK Publishers. Pp. 223-235. Ulatowska, H. K., & Freedman-Stem, R. 1978.Analysis ofaphasic nriting. Paper delivered at the Aphasia Research Group, World Federation of Neurologists, University of Iowa, Iowa City. van Dijk, T. A. 1977. Text and context. Explorations of the semantics and pragmatics of discourse. London: Longman. van Dijk, T. A., & Kintsch, W. 1978. Cognitive Psychology and Discourse in Recallings and Summarizing Stories. In W. U. Dressler (Ed.), Current trends in textlinguistics, New York: de Gruyter. Wilcox, M. J., Davis, G. A., & Leonard, L. B. 1978.Aphasics‘ comprehension of contextually conveyed meaning. Bruin and Language, 6, 362-377.