Ling 411 – 03

History of Aphasiology

1. Early Workers 2. Broca, Wernicke, Lichtheim 3. Reactions to Connectionism 4. Goldstein, Luria and Geschwind 5. Recent and Current Workers

What is aphasia?

http://www.youtube.com/watch?v=eZIWBmsqpxI :43 – 1:32

Outline of major historical periods

1.

2.

3.

4.

5.

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 a. Goodglass b. Benson and Ardila c. Paradis d. Damasio e. Psychologists f.

Poeppel and Hickock

1. Early Studies

From ancient Egypt to Broca

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.”

Hippocrates (ca. 400 BCE)

"Men ought to know that from nothing else but the brain come joys, delights, laughter and sports, and sorrows, griefs, despondency, and lamentations. And by this, in an especial manner, we acquire wisdom and knowledge, and see and hear and know what are foul and what are fair, what are bad and what are good, what are sweet and what are unsavory ... And by the same organ we become mad and delirious, and fears and terrors assail us ... All these things we endure from the brain when it is not healthy ... In these ways I am of the opinion that the brain exercises the greatest power in the man."

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 (16 th • (next slide) century, worked on cadavers) Steno (Late 17 th • century) Brain is the seat of both thought and soul

Andreas Vesalius

   1514-1564 Considered to be the father of modern anatomy “De Fabrica Humanis Corpora” • New standard for medical art

Franz Joseph Gall

  By early 1800’s, aphasia became a focus of intellectual speculation Franz Joseph Gall (1758 –1828) • Started career in Vienna, later moved to Paris • Localization of function  good idea!

• Phrenology  bad idea!

 Assumes localization of complex functions

Gall’s Phrenology Theory

Wrong, of course!

(Why?) Yet the idea of localization is a good one

Reactions to Gall

  Pierre Flourens – Attacked Gall • The brain functions holistically Supporters of Gall • Jean-Baptiste Bouillard (1825 –1881) • • Ernst Aubertin (son-in-law of Bouillard) Pierre Gratiolet

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

Marc Dax

  In unublished work of 1836 he anticipated the later major contribution of Broca Probably influenced Broca

Jean-Baptiste Bouillard (France)

     1825-1881 Improved Gall’s methods Anticipated later theories Did post-mortem exams of aphasics Proposed left frontal lobe (sometimes right) as the locus of speech

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

2. Broca, Wernicke, Lichtheim

The rise of connectionism: A sophisticated form of locationalism

Pierre Paul Broca (French, 1824-1880)

Pierre Paul Broca (1824–1880)

    Heard important presentation by Auburtin in 1861 Two days later, he got a patient who • Couldn’t 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

Broca 1861

Broca, Paul. 1861. Nouvelle observation d'aphémie produite par une lésion de la moitié postérieure des deuxième et troisième circonvolution Frontales gauches. Bulletin de la Société Anatomique 36.398-407.

Broca 1861

"The integrity of the third frontal convolution (and perhaps of the second) seems indispensable to the exercise of the faculty of articulate language ... I found that in my second patient the lesion occupied exactly the same seat as with the first – immediately behind the middle third, opposite the insula and precisely on the same side.”

Principal cortical gyri (schematic)

Pierre Paul Broca (cont’d)

     One patient had right hemisphere damage, but no speech disturbance In 1870’s, started localizing other functions Did neuroanatomical studies of dogs to investigate localization hypotheses Also recognized a different language disorder – “verbal amnesia” – but didn’t propose a location Was criticized on the grounds that some aphasics didn’t have lesion in 3 rd frontal gyrus

Broca’s major contributions

   Cerebral dominance • “We speak with the left side of our brains” Inferior frontal gyrus for speech production (“Broca’s area”*) Localization of function based on convolutional anatomy *Broca did not himself propose this designation

Karl Wernicke (German, 1848 1905)

The most im portant figure in 19 th century aphasiology

Karl Wernicke (1848-1905)

     Studied neuroanatomy with Meinert in Vienna Important paper published in 1874 (at age 26) Generally supported Broca Identified “Broca’s aphasia” as difficulty with speech production, especially of function words Also identified a posterior language area

Wernicke’s 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 Wernicke’s area

Two basic language areas

Primary Motor Area Broca’s area Primary Somato sensory Area Wernicke’s area Primary Auditory Area Primary Visual Area

Two basic language areas

Primary Motor Area Primary Somato sensory Area Phonological Production Phonological Recognition Primary Auditory Area Primary Visual Area

Wernicke: Connectionism

   Proposed the theory of connectionism (with Lichtheim) Involves localization of function, but in a more sophisticated form than predecessors Accepted Meinert’s postulation of a fiber bundle connecting the two basic language areas – arcuate fasciculus

Arcuate Fasciculus

Arcuate fasciculus Wernicke’s area Broca’s area

Wernicke: Connectionism and the arcuate fasciculus

  Wernicke learned about the arcuate fasciculus from Meinert in Vienna Predicted “Conduction Aphasia” • Would result from damage to arcuate fasciculus • 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

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 1960’s

The Wernicke-Lichtheim model (1885)

A – Auditory M – Motor B – Ideation Numbers indicate areas in which disconnection would produce distinct disorder From Lichtheim 1885

The Wernicke-Lichtheim model (1885)

Arcuate fasciculus Several different areas Broca’s area Wernicke’s area Mouth region of primary motor area Primary auditory area

Hickok’s revised diagram

(Gregory Hickock, 2000) M Conceptual Representations A Linguistic Representation Sensory-Motor Periphery

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. 1995:13)

Big lesson – Remember this!

3. The Decades following Wernicke & Lichtheim

From Marie to Goldstein (Benson & Ardila include Goldstein and Luria in this third period)

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

Diverse Views after Wernicke & Lichtheim

      Pierre Marie (France) Jules Dejerine (France) J. Hughlings Jackson (England) Henry Head (England) Kurt Goldstein (Germany) Aleksandr Luria (Russia) • But largely in agreement with Wernicke’s basic ideas

Color Code:

Attacked Wernicke Supported Wernicke Independent innovator

4. Goldstein, Luria, Geschwind: The return of connectionism

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 (or more?) kinds of conduction aphasia

Another basic language area?

Central Sulcus Broca’s area Central area Wernicke’s area Primary Auditory Area Primary Visual Area

Luria’s position

according 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… Benson & Ardila 1996:19-20 Question: Is this really a “midway stance”?

Good and bad localizationist models

  Bad (e.g., Gall’s 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

Norman Geschwind (1926-1984)    Born in New York City Trained: Harvard medical school and London’s National Hospital Career: • Boston VA hospital  Chief of neurology • Boston University, neurology  Established Boston U Aphasia Research Center • Trained a generation of leading neurologists  Incl. Goodglass, Benson, Damasio • Revived the Wernicke-Lichtheim theory

Norman Geschwind on Wernicke (1966)

Wernicke’s reasoning was simple. He applied Meynert’s 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.

Norman Geschwind on Wernicke (1966) (cont’d) 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.

Norman Geschwind on Wernicke (1966) (cont’d) 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.

Norman Geschwind on Wernicke (1966) (cont’d) 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 Wernicke’s paper amply confirmed these hypotheses.

Intellectual lineages

Leading Aphasiologists Geschwind (Boston) Wernicke Lichtheim Goldstein Luria (Moscow) Goodglass Benson Damasio Ardila

5. Present and Recent Past

Ardila Benson Goodglass Damasio Psychologists Other contemporaries

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 Chomsky’s formulations about language

Modern attacks on Wernicke-Geschwind connectionism

  John Pinel • Surgical excisions of important language areas fail to result in aphasia Blumstein, Pinker, Pulvermüller • Erratic speech output of Wernicke’s aphasics

Broca’s 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

(1990:560), Adapted from Penfield & Roberts, 1959

Broca’s 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

(1990:560), Adapted from Penfield & Roberts, 1959

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)

Doubts about Wernicke’s Area

Steven Pinker: Wernicke’s area …was once thought to underlie language comprehension. But that would not explain why the speech of these patients sounds so psychotic.

The Language Instinct

(1994) Friedemann Pulverm üller: …patients with Wernicke’s aphasia have difficulty speaking…. These deficits are typical…and cannot be easily explained by assuming a selective lesion to a center devoted to language comprehension.

The Neuroscience of Language

(2002)

Erratic Speech in Wernicke’s Aphasia

“I feel very well. My hearing, writing been doing well. Things that I couldn’t hear from. In other words, I used to be able to work cigarettes. I didn’t know how…. Chesterfeela, for 20 years I can write it.” From Harold Goodglass

Understanding Aphasia

(1993)

Phonological Production / Speaking

   Speaking is a complex process • Therefore, involves multiple areas Phonological production is a simple process • Broca’s area  together with parts of primary motor area and subcortical areas Other processes in speaking • (other than phonological production)

Phonological Recognition / Understanding

   Understanding speech is a complex process • Therefore, involves multiple areas Phonological recognition is a simple process • Wernicke’s area  together with primary auditory area and subcortical areas Other processes in understanding • (other than phonological recognition)

Lessons from Carl Wernicke

Carl Wernicke: Primary functions alone can be referred to specific areas…. All processes which exceed these primary functions…are dependent on the fiber bundles, that is, association.

Aphasia Symptom Complex

(1874) Any higher psychic processes exceeding these primary assumptions cannot be localized but rest on the mutual interaction of these fundamental psychic elements which mediate their manifold relations by means of the association fibers.

Recent Works on Aphasia

(1885-86)

Simple Functions / Complex Functions

Complex function Simple function

Wernicke and Connectionism

Kandel, Schwarz, and Jessel: “ …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.”

Essentials of Neural Science and Behavior

(1995:13)

Basic functions and complex functions    Phonological recognition is a basic function It is located in Wernicke’s area • along with, perhaps, the area intermediate between primary auditory area and W’s area Speaking is a complex function • It is a cooperative effort of several areas, including Broca’s area and Wernicke’s area • Phonological recognition is a necessary component of speaking

Wernicke’s Area and Speaking

    Phonological images guide speech production Phonological recognition monitors production Compare..

• Painting without visual perception • Playing a piano without auditory perception Conclusion:

Of course

phonological recognition (i.e. Wernicke’s area) plays a role in speech production

Pulvermüller’s Statement …patients with Wernicke’s aphasia have difficulty speaking…. These deficits are typical…and cannot be easily explained by assuming a selective lesion to a center devoted to language comprehension.

The Neuroscience of Language

(2002)

Paraphrasing Pulverm üller …patients with Wernicke’s aphasia have difficulty speaking…. These deficits are typical…and cannot be easily explained by assuming a selective lesion to a center devoted to language comprehension .

The Neuroscience of Language

(2002) Altered quote: …patients with damage to the occipital lobe have difficulty drawing pictures…. These deficits are typical…and cannot be easily explained by assuming a selective lesion to a center devoted to visual perception .

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