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Recovery from aphasia after polytrauma in a Czech child: What is lost and what is left
Brain and Language 87 (2003) 163–164 www.elsevier.com/locate/b&l
Recovery from aphasia after polytrauma in a Czech child: What is lost and what is left Helena Lehecˇkova´ Department of Slavonic and Baltic Languages, University of Helsinki, Finland
A case study is presented of a Czech-speaking child with acquired aphasia. The patient (right-handed, female) was 11 years old when she sustained multiple severe injuries in a car accident. Long-lasting intensive care was started during the traumatic shock-state accompanied by multiple organic failures. There was an extensive craniocerebral contusion. Most of the lesions were situated in both frontal regions, with prevalence on the left side and with a bilateral subdural haematoma. In the beginning, the patient was in a deep comatose state. With the appearance of signs of consciousness many neurological deficits were manifested: hemiparesis on the right side, cerebellar symptomatology, severe psychosyndroma, and global aphasia. The peripheral traumatic lesions were compensated for after 3–4 months and a slow amelioration of cerebral functions followed. Goal The aim of this study is to describe the aphasic symptoms in a child during her re-acquisition of language and to compare them with aphasic symptoms in Czech adults.
Material Spontaneous speech Six months post-onset the patient produced no spontaneous speech except for perseverance on two words: ma´ma (Mom) and ne (no). Two and a half years after the polytrauma the organic and motoric problems had disappeared and she was diagnosed with amnestic aphasia. I recorded her speech on her illness, school, friends and hobbies. Her speech was fluent, with normal melody and intonation, without articulatory difficulties. As long as our conversation stayed on the level of small talk there were no abnormalities observable. However, deeper discussion revealed substantial word-finding difficulties and ‘‘emptiness’’ in her language. The material consists of about one hour’s recording. There were 3256 words in 543 clauses, out of which 14% were ungrammatical. Eighty percent of errors can be classified as omissions and 20% as substitutions. Surprisingly enough, omissions affected mostly content words (in 80%), not grammatical ones. Grammatical tests I tested the patient on prepositions and prefixes because they usually cause difficulties even to patients with a mild impairment. 0093-934X/$ - see front matter Ó 2003 Elsevier Inc. All rights reserved. doi:10.1016/S0093-934X(03)00251-7
Test no.
Grammatical features tested
Error rate (%)
Time (min)
1 2
Prepositions with lexical meaning Prepositions with grammatical meaning Grammatical prefixes Directional/spatial prefixes Idiomatic prefixes
9 12
25 25
5 40 25
7 25 20
3 4 5
While in spontaneous speech there were not many errors in using prepositions and none in prefixes, the tests revealed grammatical uncertainty, especially in items without lexical meaning. Writing The patient suffered from total agraphia after the accident. Even now she keeps forgetting the shape of letters and prefers to write by computer. Her writing contains no major lexical or grammatical mistakes but it completely neglects orthographic rules that had been mastered before. Spontaneous writing seems to adjust to spontaneous speech: the orthography of single words reflects only their phonetic representation and the text is not structured by punctuation. Discussion I compared the present case with that of an adult aphasic. The patient (female, right-handed, computer maintenance person) was 52 years old when she suffered a haemorrhage in the left parietal region, with right-sided hemiparesis and mixed aphasia. I examined her two years post-onset. She was diagnosed for residual hemiparesis on the right side, agraphia, alexia, and amnestic aphasia. I recorded her speech on her illness, her work and her hobbies. The analysed material comprises four 126 words in 824 clauses, out of which 11% were ungrammatical. Among the errors 71% were classified as omissions and 29% were substitutions. The rates are analogous to the child’s score. Most of the omissions affected finite verbs (46% in the child and 45% in the adult). A detailed comparison of the spontaneous speech of the child and the adult shows no striking differences either in quantity or quality. Nevertheless, the child’s production appears to be more normal. The child neither notices nor corrects her errors, while the adult patient is
164
Abstract / Brain and Language 87 (2003) 163–164
very upset about her mistakes. The adult compensates for word-finding difficulties with a very slow rate of speech and long pauses during which she looks for words from the same lexical field. In contrast, the child replaces the missing lexemes with neologisms or indefinite expressions. In grammatical tests the patients scored differently. The adult made many errors in prepositions in spontaneous speech but none in tests. The child showed the reverse tendency. Writing could not be compared, owing to the adult patient’s continuing right hemiparesis.
those of the comparable case of adult aphasia and with aphasic symptoms in Czech in general (cf. Lehecˇkova´, 2001). What is lost, 3 years after the accident, is fluent writing and reading, smooth access to the whole lexicon and sensitivity to some grammatical features, especially those with a formal character only. What is re-achieved after an almost hopeless state is the ability to use language for communication and reflection. While the adult patient two years post-onset reached a stage after which her language skills no longer improved, the child has been continuing to develop her linguistic abilities.
Conclusion Reference The child recovered remarkably well from a serious polytrauma and a four month comatose state. However, language has not been fully restored. The aphasic symptoms of the child are identical with
Lehecˇkova´, H. (2001). Manifestation of aphasic symptoms in Czech. Journal of Neurolinguistics, 14, 179–208.
Recovery from aphasia after polytrauma in a Czech child: What is lost and what is left Helena Lehecˇkova´ Department of Slavonic and Baltic Languages, University of Helsinki, Finland
A case study is presented of a Czech-speaking child with acquired aphasia. The patient (right-handed, female) was 11 years old when she sustained multiple severe injuries in a car accident. Long-lasting intensive care was started during the traumatic shock-state accompanied by multiple organic failures. There was an extensive craniocerebral contusion. Most of the lesions were situated in both frontal regions, with prevalence on the left side and with a bilateral subdural haematoma. In the beginning, the patient was in a deep comatose state. With the appearance of signs of consciousness many neurological deficits were manifested: hemiparesis on the right side, cerebellar symptomatology, severe psychosyndroma, and global aphasia. The peripheral traumatic lesions were compensated for after 3–4 months and a slow amelioration of cerebral functions followed. Goal The aim of this study is to describe the aphasic symptoms in a child during her re-acquisition of language and to compare them with aphasic symptoms in Czech adults.
Material Spontaneous speech Six months post-onset the patient produced no spontaneous speech except for perseverance on two words: ma´ma (Mom) and ne (no). Two and a half years after the polytrauma the organic and motoric problems had disappeared and she was diagnosed with amnestic aphasia. I recorded her speech on her illness, school, friends and hobbies. Her speech was fluent, with normal melody and intonation, without articulatory difficulties. As long as our conversation stayed on the level of small talk there were no abnormalities observable. However, deeper discussion revealed substantial word-finding difficulties and ‘‘emptiness’’ in her language. The material consists of about one hour’s recording. There were 3256 words in 543 clauses, out of which 14% were ungrammatical. Eighty percent of errors can be classified as omissions and 20% as substitutions. Surprisingly enough, omissions affected mostly content words (in 80%), not grammatical ones. Grammatical tests I tested the patient on prepositions and prefixes because they usually cause difficulties even to patients with a mild impairment. 0093-934X/$ - see front matter Ó 2003 Elsevier Inc. All rights reserved. doi:10.1016/S0093-934X(03)00251-7
Test no.
Grammatical features tested
Error rate (%)
Time (min)
1 2
Prepositions with lexical meaning Prepositions with grammatical meaning Grammatical prefixes Directional/spatial prefixes Idiomatic prefixes
9 12
25 25
5 40 25
7 25 20
3 4 5
While in spontaneous speech there were not many errors in using prepositions and none in prefixes, the tests revealed grammatical uncertainty, especially in items without lexical meaning. Writing The patient suffered from total agraphia after the accident. Even now she keeps forgetting the shape of letters and prefers to write by computer. Her writing contains no major lexical or grammatical mistakes but it completely neglects orthographic rules that had been mastered before. Spontaneous writing seems to adjust to spontaneous speech: the orthography of single words reflects only their phonetic representation and the text is not structured by punctuation. Discussion I compared the present case with that of an adult aphasic. The patient (female, right-handed, computer maintenance person) was 52 years old when she suffered a haemorrhage in the left parietal region, with right-sided hemiparesis and mixed aphasia. I examined her two years post-onset. She was diagnosed for residual hemiparesis on the right side, agraphia, alexia, and amnestic aphasia. I recorded her speech on her illness, her work and her hobbies. The analysed material comprises four 126 words in 824 clauses, out of which 11% were ungrammatical. Among the errors 71% were classified as omissions and 29% were substitutions. The rates are analogous to the child’s score. Most of the omissions affected finite verbs (46% in the child and 45% in the adult). A detailed comparison of the spontaneous speech of the child and the adult shows no striking differences either in quantity or quality. Nevertheless, the child’s production appears to be more normal. The child neither notices nor corrects her errors, while the adult patient is
164
Abstract / Brain and Language 87 (2003) 163–164
very upset about her mistakes. The adult compensates for word-finding difficulties with a very slow rate of speech and long pauses during which she looks for words from the same lexical field. In contrast, the child replaces the missing lexemes with neologisms or indefinite expressions. In grammatical tests the patients scored differently. The adult made many errors in prepositions in spontaneous speech but none in tests. The child showed the reverse tendency. Writing could not be compared, owing to the adult patient’s continuing right hemiparesis.
those of the comparable case of adult aphasia and with aphasic symptoms in Czech in general (cf. Lehecˇkova´, 2001). What is lost, 3 years after the accident, is fluent writing and reading, smooth access to the whole lexicon and sensitivity to some grammatical features, especially those with a formal character only. What is re-achieved after an almost hopeless state is the ability to use language for communication and reflection. While the adult patient two years post-onset reached a stage after which her language skills no longer improved, the child has been continuing to develop her linguistic abilities.
Conclusion Reference The child recovered remarkably well from a serious polytrauma and a four month comatose state. However, language has not been fully restored. The aphasic symptoms of the child are identical with
Lehecˇkova´, H. (2001). Manifestation of aphasic symptoms in Czech. Journal of Neurolinguistics, 14, 179–208.