Agrammatism: Deficit or compensation? Consequences for aphasia therapy

Abstract

During the natural course of aphasia, agrammatism occurs as a symptom complex of either the acute or the chronic phase. Distinguishing these two clinical forms, we discuss its underlying nature in term of deficit and compensation. Furthermore, variations due to adaptation and/or restriction in information processing capacities are considered. In recent years, we developed a new approach to the treatment of severe agrammatism, which is called Reduced Syntax Therapy (REST, Schlenck, Schlenck, & Springer, 1995). This approach comprises three major features: (1) activation of functional level information, (2) mapping of thematic roles onto simplified syntactic structures, and (3) leaving aside morphosyntactic markings. From a linguistic point of view, only basic processes of constituent structure formation are considered, which are in part also present in elliptic speech of normal speakers. The patients are instructed to expand one-word utterances into two- and three-constituent utterances in several steps, while ignoring function words and inflectional endings. The efficacy of REST was studied in 11 patients with severe chronic agrammatism due to extensive left hemisphere lesions. In 9 patients significant expansion of simple phrase structures could be achieved whereas increase in closed class elements (function words and inflectional endings) remained small and limited to few patients. Therefore, we concluded that REST most likely enhances elementary proto-language functions of labelling and sequencing in the unimpaired right hemisphere, which may become the starting point for a gradual and laborious learning of simple syntax and grammar.