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History of Aphasiology

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Title: History of Aphasiology


1
History of Aphasiology
Ling 411 03
  • 1. Early Workers
  • 2. Broca, Wernicke, Lichtheim
  • 3. Reactions to Connectionism
  • 4. Goldstein, Luria and Geschwind
  • 5. Recent Workers

2
Outline of major historical periods
  • Early studies Up to Broca
  • Broca, Wernicke, Lichtheim Connectionism
  • The decades following Wernicke Lichtheim
  • Goldstein, Luria, Geschwind
  • The return of connectionism
  • Present and recent past
  • Goodglass
  • Benson and Ardila
  • Damasio
  • Psychologists

3
1. Early Studies
  • From ancient Egypt to Broca

4
An Egyptian surgeon, ca. 3000 B.C.
  • If you examine a man with a broken temple,
    when you speak to him, he does not answer, he has
    lost his use of words.

5
Early European thinking
  • Aristotle
  • Heart is the center of intelligence
  • Brain is for cooling blood
  • Galen (Greek, 130(?) 201(?) a.d.)
  • Dissected animals
  • Brain is center of thinking and feeling
  • Vesalius (16th century, worked on cadavers)
  • Steno (Late 17th century)
  • Brain is the seat of both thought and soul

6
Franz Joseph Gall
  • By early 1800s, aphasia became a focus of
    intellectual speculation
  • Franz Joseph Gall (17581828)
  • Started career in Vienna, later moved to Paris
  • Localization of function
  • good idea!
  • Phrenology
  • bad idea!

7
Galls Phrenology Theory
Wrong, of course! (Why?) Yet the idea of
localization is a good one
8
Reactions to Gall
  • Pierre Flourens Attacked Gall
  • The brain functions holistically
  • Supporters of Gall
  • Jean-Baptiste Bouillard (18251881)
  • Ernst Aubertin (son-in-law of Bouillard)
  • Pierre Gratiolet

9
A decades-long debate
  • Locationism vs. Holism
  • Started with reactions to Gall
  • Gall a naïve locationist
  • At first, it was assumed that all locationalism
    was necessarily naïve
  • The only alternative seen was holism
  • Debate flourished for decades
  • Mainly in France, England, Germany

10
Marc Dax
  • In unublished work of 1836 he anticipated the
    later major contribution of Broca
  • Probably influenced Broca

11
Jean-Baptiste Bouillard (France)
  • 1825-1881
  • Improved Galls methods
  • Anticipated later theories
  • Did post-mortem exams of aphasics
  • Proposed left frontal lobe (sometimes right) as
    the locus of speech

12
Ernst Auburtin (France)
  • Son-in-law of Bouillard
  • Supported the theory of localization of brain
    functions in discrete brain areas
  • Presented an important paper in 1861
  • Broca was in the audience
  • Broca invited Aubertin to examine one of his
    patients

13
2. Broca, Wernicke, Lichtheim
  • The rise of connectionism
  • A sophisticated form of locationalism

14
Pierre Paul Broca (French,1824-1880)
15
Pierre Paul Broca (18241880)
  • Heard important presentation by Auburtin in 1861
  • Two days later, he got a patient who
  • Couldnt talk
  • Had malfunction of right side of body
  • Died 5 days later
  • Broca performed autopsy
  • Found lesion in third frontal convolution
  • Second patient, also aphasic, also had lesion in
    inferior frontal gyrus

16
Principal cortical gyri (schematic)
17
Pierre Paul Broca (contd)
  • One patient had right hemisphere damage, but no
    speech disturbance
  • In 1870s, started localizing other functions
  • Did neuroanatomical studies of dogs to
    investigate localization hypotheses
  • Also recognized a different language disorder
    verbal amnesia but didnt propose a location
  • Was criticized on the grounds that some aphasics
    didnt have lesion in 3rd frontal gyrus

18
Brocas major contributions
  • Cerebral dominance
  • We speak with the left side of our brains
  • Inferior frontal gyrus for speech production
    (Brocas area)
  • Localization of function based on convolutional
    anatomy

Broca did not himself propose this designation
19
Karl Wernicke (German, 1848-1905)
The most im-portant figure in 19th century
aphasiology
20
Karl Wernicke (1848-1905)
  • Studied neuroanatomy with Meinert in Vienna
  • Important paper published in 1874 (at age 26)
  • Generally supported Broca
  • Identified Brocas aphasia as difficulty with
    speech production, especially of function words
  • Also identified a posterior language area

21
Wernickes posterior language area
  • In posterior superior temporal lobe
  • Important for speech comprehension
  • If damaged, comprehension impaired
  • If damaged, speech is repetitive
  • Patient is unaware of his errors
  • Locus of auditory images of words
  • Now known as Wernickes area

22
Two basic language areas
Primary Somato- sensory Area
Primary Motor Area
Brocas area
Wernickes area
Primary Auditory Area
Primary Visual Area
23
Two basic language areas
Primary Somato- sensory Area
Primary Motor Area
Phonological Recognition
Phonological Production
Primary Auditory Area
Primary Visual Area
24
Wernicke Connectionism
  • Proposed the theory of connectionism (with
    Lichtheim)
  • Involves localization of function, but in a more
    sophisticated form than predecessors
  • Accepted Meinerts postulation of a fiber bundle
    connecting the two basic language areas arcuate
    fasciculus

25
Arcuate Fasciculus
26
Wernicke Connectionismand the arcuate fasciculus
  • Wernicke had learned about it from Meinert in
    Vienna
  • Predicted Conduction Aphasia
  • Would result from damage to this bundle
  • Such a patient would be unable to transmit
    auditory identification to speech production area
  • Hence, impaired repetition
  • Later, he encountered a patient with just this
    problem

27
Ludwig Lichtheim (German, 1845-1928)
  • Worked with Wernicke
  • Proposed a connectionist-locationist scheme with
    now-famous diagram, 1885
  • Accepted by Wernicke
  • The birth of connectionism
  • This scheme was widely criticized for several
    subsequent decades
  • Revived by Norman Geschwind in 1960s

28
The Wernicke-Lichtheim model (1885)
A Auditory M Motor B Ideation Numbers
indicate areas in which disconnection would
produce distinct disorder From Lichtheim 1885
29
Hickoks revised diagram
(Gregory Hickock, 2000)
Conceptual Representations Linguistic Represen
tation Sensory-Motor Periphery
M
A
30
The Wernicke-Lichtheim model (1885)
Several different areas
Arcuate fasciculus
Brocas area Mouth region of primary motor area
Wernickes area Primary auditory area
31
Wernicke and Connectionism
Based on on his discoveries and those of Broca,
Fritsch, and Hitzig, Wernicke proposed (1876)
that only the most basic mental functions, those
concerned with simple perceptual and motor
activities, are localized to single areas of the
cortex, and that more complex intellectual
functions result from interconnections between
several functional sites. In placing the
principle of localized function within a
connectionist framework, Wernicke appreciated
that different components of a single behavior
are processed in different regions of the brain.
He thus advanced the first evidence for the idea
of distributed processing, which is now central
to our understanding of brain function.
(Kandel et al. 199513)
Big lesson Remember this!
32
3. The Decades following Wernicke Lichtheim
  • From Marie to Goldstein
  • (Benson Ardila include Goldstein
  • and Luria in this third period)

33
Jules Dejerine (French)
  • 1901 Accepted basic ideas of Wernicke and
    Lichtheim
  • But rejected the concept center depicted in their
    diagram no anatomical basis
  • Added account of reading problems alexia
  • Visual-verbal zone in left angular gyrus

34
Diverse Views after Wernicke Lichtheim
  • Pierre Marie (France)
  • Jules Dejerine (France)
  • J. Hughlings Jackson (England)
  • Henry Head (England)
  • Kurt Goldstein (Germany)
  • Aleksandr Luria (Russia)

Color Code Attacked Wernicke Supported
Wernicke Independent innovator
35
4. Goldstein, Luria, Geschwind The return of
connectionism
36
Kurt Goldstein (1878-1965)
  • German
  • Studied with Wernicke
  • Influenced by Gestalt psychology (Koffka 1935)
  • Adopted a holistic approach
  • Became the best-known spokesman for this approach
  • Important publication in 1948
  • Criticized the Wernicke-Lichtheim view of
    conduction aphasia
  • Not the arcuate fasciculus but a central area
  • Proposed the term Central Aphasia
  • Now we see that there are really two kinds of
    conduction aphasia

37
Another basic language area?
Central Sulcus
Central area
Brocas area
Wernickes area
Primary Auditory Area
Primary Visual Area
38
Another basic language area?
Central Sulcus
Goldsteins area
Brocas area
Wernickes area
Primary Auditory Area
Primary Visual Area
39
Lurias positionaccording to Benson Ardila
Luria took a midway stance between the
localizationist and holistic approaches. He
considered language to be a complex functional
system, requiring many different steps in both
comprehension and production simultaneous
participation of multiple cortical areas would be
required for language processing. Although each
cortical area performs a specific process, it
also participates in different functional
systems. Thus, the first temporal gyrus
participates in phoneme discrimination, and its
damage causes difficulty in all functional
systems requiring phoneme discrimination Ben
son Ardila 199619-20 Question Is this really
a midway stance?
40
Good and bad localizationist models
  • Bad (e.g., Galls phrenology)
  • Each local center does a fairly large job, all by
    itself
  • Good (e.g. Wernicke-Lichtheim)
  • Each local center does a very small job
  • Large jobs get done by the operation of several
    or many such local centers working together,
    partly in serial, partly in parallel
    distributed processing
  • A local center can participate in several
    different kinds of larger jobs, depending on what
    other centers are working together with it

41
Norman Geschwind (1926-1984)
  • Born in New York City
  • Trained Harvard medical school and Londons
    National Hospital
  • Career
  • Boston VA hospital
  • Chief of neurology
  • Boston University, neurology
  • Established Boston U Aphasia Research Center
  • Trained a generation of leading neurologists
  • Revived the Wernicke-Lichtheim theory

42
Norman Geschwind on Wernicke (1966)
Wernickes reasoning was simple. He applied
Meynerts teaching on the fiber tracts of the
brain to the problem of aphasia. The
phrenologists, he argued, had been wrong in their
attempt to localize such complex mental
attributes as magnanimity or filial love what
was actually localizable were much simpler
perceptual and motor functions. All the complex
array of human intellectual attributes must
somehow be woven from these few threads of
different texture. The cortex could provide two
means of achieving this higher integration it
could store sensory traces in cells and, by
means of association fiber tracts, it could link
together different parts of the system.
43
Norman Geschwind on Wernicke (1966) (contd)
Meynert had already pointed out that what lay
anterior to the fissure of Rolando was motor in
function, what lay behind it was sensory. It
seemed most reasonable to assume that traces of
sensory impressions or of motor patterns should
somehow be stored in regions adjacent to the
appropriate elementary zones in the cortex.
44
Norman Geschwind on Wernicke (1966) (contd)
The application to speech was immediate. Hitzig
had already shown that at the lower end of the
Rolandic cortex was a zone which, when stimulated
on one side, led to bilateral movements of the
mouth and the tongue. It was reasonable to assume
that immediately in front of this zone lay a
region where patterns of articulatory movements
might be stored. This was exactly where Broca had
placed the lesions in his cases, a localization
repeatedly to be confirmed.
45
Norman Geschwind on Wernicke (1966) (contd)
Meynert had asserted that the central end of the
acoustic pathways lay in the vicinity of the
Sylvian fissure. Thus it was reasonable to assume
that traces of words should be stored near this
zone. If this were the case, then an aphasia with
loss of comprehension should result from lesions
in this neighborhood. Necropsy of the patients
recorded in Wernickes paper amply confirmed
these hypotheses.
46
Intellectual lineagesLeading Aphasiologists
Wernicke Lichtheim Goldstein
Luria (Moscow) Ardila
Geschwind (Boston) Goodglass
Benson Damasio
47
Intellectual lineagesLeading Aphasiologists
Wernicke Lichtheim Goldstein
Germany
Russia
Luria (Moscow) Ardila
Geschwind (Boston) Goodglass
Benson Damasio
U.S.A.
48
5. Present and Recent Past
  • Ardila
  • Benson
  • Goodglass
  • Damasio
  • Psychologists
  • Other contemporaries

49
The Great Divide
  • Clinical Aphasiologists
  • Largely accept modern reformulations of
    Geschwind-Lichtheim connectionism, following
    Geschwind
  • E.g., Goodglass, Benson, Damasio
  • Psychologists
  • E.g. Blumstein, Caramazza, Pinker
  • Tend to reject Wernicke-Geschwind thinking
  • Sometimes make unsophisticated assumptions
    without evidence
  • Some try to make use of Chomskys formulations
    about language

50
Modern attacks onWernicke-Geschwind connectionism
  • John Pinel
  • Surgical excisions of important language areas
    fail to result in aphasia
  • Blumstein, Pinker, Pulvermüller
  • Erratic speech output of Wernickes aphasics

51
Brocas Area Not for Speech Production?
Surgical excision was done in two stages.
Following completion of the second stage, no
speech-related problems were reported.
Patient D.H.
John Pinel, Biopsychology (1990560), Adapted
from Penfield Roberts, 1959
52
Brocas Area Not for Speech Production?
What Pinel neglects to mention, but it is in
Penfield Roberts Patient D.H. was a young boy
who had been having seizures, originating in this
part of his brain.
Patient D.H.
John Pinel, Biopsychology (1990560), Adapted
from Penfield Roberts, 1959
53
More on patient D.H.
  • Eighteen years old at time of surgery
  • Had suffered from seizures causing an inability
    to speak from the age of 3 1/2
  • Apparently, the congenital abnormality had
    caused displacement of function

Penfield Roberts Speech and Brain
Mechanisms (1959 163)
54
end
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