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Sentence comprehension by children after closed head injury Noort, Marilyn 1989

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SENTENCE COMPREHENSION BY CHILDREN AFTER CLOSED HEAD INJURY  by  MARILYN NOORT B. A., University of British Columbia, 1986  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE  Faculty of Graduate Studies The School of Audiology and Speech Sciences  We accept this thesis as conforming to the required standard  THE UNIVERSITY OF BRITISH COLUMBIA September, 1989 © Marilyn Noort, 1989  In  presenting  degree freely  at  this  the  available  copying  of  department publication  of  in  partial  fulfilment  University  of  British  Columbia,  for  this or  thesis  reference  thesis by  this  for  his thesis  and  scholarly  or for  her  of  The University of British Columbia Vancouver, Canada  DE-6 (2/88)  I  1 further  purposes  gain  the  requirements  agree  that  agree  may  be  It  is  representatives.  financial  permission.  Department  study.  of  shall  not  that  the  for  Library  permission  granted  by  understood be  allowed  the  an  advanced  shall for  make  extensive  head  that  without  it  of  copying my  my or  written  ABSTRACT  T h i s study i s an i n v e s t i g a t i o n o f c l o s e d h e a d - i n j u r e d ( C H I ) c h i l d r e n ' s a b i l i t y to assign thematic roles to n o u n s i n sentences o f v a r y i n g syntactic structure. S e v e n C H I c h i l d r e n , a g e d 9 to 15 years, p a r t i c i p a t e d as subjects.  A l l subjects w e r e at least t w o m o n t h s post-  onset a n d d e m o n s t r a t e d s y m p t o m s t a b i l i z a t i o n .  T h e p r o c e d u r e r e p l i c a t e d a task d e s i g n e d by  C a p l a n , B a k e r a n d D e h a u t ( 1 9 8 5 ) , w h i c h requires that subjects enact o r a l l y presented sentences b y m a n i p u l a t i n g toy a n i m a l s .  F o u r questions w e r e addressed:  1) Is the  assignment o f thematic r o l e m o r e d i f f i c u l t i n s o m e sentence structures than i n others f o r closed head-injured and normal children?  2) D o C H I c h i l d r e n h a v e m o r e d i f f i c u l t y  a s s i g n i n g thematic r o l e than d o n o r m a l c h i l d r e n ?  3) A r e any p a r t i c u l a r sentence types  r e l a t i v e l y m o r e susceptible to interpretation b r e a k d o w n than other sentence types?  4)  Does  the pattern o f sentence interpretation b r e a k d o w n i n C H I c h i l d r e n r e s e m b l e that f o u n d i n C H I adults a n d aphasic adults?  T h e c l o s e d h e a d i n j u r e d subjects as a g r o u p p r o d u c e d  m o r e errors than the age- a n d s e x - m a t c h e d c o n t r o l s .  F u t h e r m o r e , s o m e sentence structures  w e r e m o r e d i f f i c u l t to interpret than w e r e others f o r b o t h h e a d i n j u r e d a n d c o n t r o l subjects. T h e h i e r a r c h i c a l o r d e r o f d i f f i c u l t y f o r both g r o u p s w a s s i m i l a r to the o r d e r f o u n d f o r adult c l o s e d h e a d i n j u r e d patients a n d adult aphasics.  S e v e r a l syntactic structural features -  - n o n c a n o n i c a l w o r d o r d e r , presence o f a t h i r d thematic r o l e , a n d presence o f a second v e r b — w e r e s h o w n to i n f l u e n c e sentence c o m p l e x i t y .  T h e s e features affect syntactic  interpretation b y b r a i n i n j u r e d subjects regardless o f e t i o l o g y .  T h e results o f this study  suggest that strategies u s e d f o r sentence p a r s i n g are s i m i l a r across b r a i n i n j u r e d p o p u l a t i o n s , regardless o f age.  ii  T A B L E O F CONTENTS  ABSTRACT  ii  T A B L E OF CONTENTS  iii  LIST O F T A B L E S  v  ACKNOWLEDGEMENTS  vii  C H A P T E R 1: INTRODUCTION  1  Aphasia in Adults after Closed Head Injury  3  Aphasia in Children after Closed Head Injury  6  Disorders of Syntactic Comprehension  12  C H A P T E R 2: M E T H O D  15  Procedure  15  Subjects  16  Individual subject descriptions  17  Subject 1 - K P  17  Subject 2 - K T  18  Subject 3 - K F  19  Subject 4 - K V  20  Subject 5 - D T  21  iii  Subject 6 - RB  22  Subject 7 - W G  23  C H A P T E R 3: RESULTS  25  C H A P T E R 4: DISCUSSION  33  BIBLIOGRAPHY  40  APPENDIX  44  iv  LIST OF T A B L E S  T a b l e 1.  Sentence T y p e s T e s t e d w i t h T h e m a t i c R o l e B a t t e r y  16  T a b l e 2.  Subject Descriptions  17  T a b l e 3.  M e a n s a n d standard d e v i a t i o n s b y sentence type f o r c o m b i n e d C F f l a n d n o r m a l  control groups T a b l e 4.  26  A n a l y s i s of Variance Summary: combined closed head injured and normal control  groups T a b l e 5.  26  R e s u l t s o f T u k e y ' s P r o c e d u r e ( e x p e r i m e n t - w i s e error rate o f 0.05)  a p p l i e d across  sentence t y p e f o r c o m b i n e d C H I a n d c o n t r o l g r o u p s  27  T a b l e 6.  M e a n s a n d standard d e v i a t i o n s b y sentence type f o r C H I g r o u p  28  T a b l e 7.  A n a l y s i s o f V a r i a n c e S u m m a r y : C l o s e d H e a d Injured Subjects  28  T a b l e 8.  M e a n s a n d standard d e v i a t i o n s b y sentence type f o r n o r m a l c o n t r o l g r o u p  T a b l e 9.  A n a l y s i s o f V a r i a n c e S u m m a r y : N o r m a l C o n t r o l Subjects  . . . .  29 29  T a b l e 10. A n a l y s i s o f V a r i a n c e S u m m a r y : T w o factor (group) repeated measures (sentence type)  30  T a b l e 11. Q u e s t i o n s addressed i n the present i n v e s t i g a t i o n  v  34  LIST OF FIGURES  F i g u r e 1.  M e a n percent o f sentences a n s w e r e d c o r r e c t l y b y C H I ( o p e n bars) a n d n o r m a l  c o n t r o l (slashed bars) subjects  25  vi  ACKNOWLEDGEMENTS  I w i s h to express m y thanks to D r . C a r o l y n J o h n s o n a n d D r . J o h n G i l b e r t w h o gave me g u i d a n c e a n d support throughout this project, to L y n n e B r o w n w h o h e l p e d locate subjects, and to the c h i l d r e n a n d parents w h o p a r t i c i p a t e d i n this study.  I w o u l d also l i k e to thank  J o h n N i c o l w h o w a s a l w a y s w i l l i n g to h e l p w h e n c o m p u t e r s i n g e s t e d d o c u m e n t s o r printers w e n t berserk. S p e c i a l thanks are d u e to m y classmates, w h o h e l p e d i n n u m e r o u s w a y s o v e r the last f i v e years, a n d to m y f r i e n d , R i c h a r d L e c h l e i t n e r , w h o gave m e  encouragement,  m o t i v a t i o n , a n d endless hours o f t y p i n g w h e n he c o u l d have been i n the m o u n t a i n s .  vii  CHAPTER 1  INTRODUCTION  T h e t e r m c l o s e d h e a d i n j u r y ( C H I ) i s u s e d to describe traumatic b r a i n i n j u r y w i t h r e s u l t i n g c e r e b r a l d y s f u n c t i o n o c c u r r i n g as a c o n s e q u e n c e o f nonpenetrating h e a d i n j u r y ( A d a m o v i c h , H e n d e r s o n a n d A u r b a c h , 1985).  It e x c l u d e s cases o f penetrating traumatic  h e a d i n j u r y f r o m m i s s i l e w o u n d s a n d cases o f nontraumatic h e a d i n j u r y o c c u r r i n g f r o m s u c h i n c i d e n t s as c a r d i o v a s c u l a r accidents, n e o p l a s m o r abscess. o f C H I are m o t o r v e h i c l e accidents a n d f a l l s .  T h e m o s t c o m m o n causes  I n the U n i t e d States, the estimated i n c i d e n c e  o f traumatic h e a d i n j u r y is 2 0 0 per 100,000 p o p u l a t i o n per y e a r ( A n n e g e r s a n d K u r l a n d , 1979).  F o r those u n d e r 35 years o f age it is the m o s t c o m m o n cause o f death ( A n n e g e r s ,  G r a b o w , K u r l a n d a n d L a w s , 1980). suffer h e a d i n j u r i e s .  A m o n g adults, m a l e s are m o r e l i k e l y than f e m a l e s to  T h e male/female injury ratio is approximately equal i n children and  adults o v e r 7 0 years o f age ( F i e l d , 1976).  E q u i v a l e n t C a n a d i a n i n c i d e n c e i n f o r m a t i o n is  u n a v a i l a b l e but l i k e l y a p p r o x i m a t e s rates i n the U n i t e d States. C l o s e d h e a d i n j u r y is associated w i t h d i f f u s e b r a i n i n j u r y a n d c o n c u s s i o n . Investigations o f the p a t h o p h y s i o l o g y o f c l o s e d h e a d i n j u r y have suggested that t w o types o f t r a u m a o c c u r : p r i m a r y i m p a c t i n j u r y a n d secondary b r a i n i n j u r y .  P r i m a r y i m p a c t injuries  result from d i r e c t i m p a c t a n d acceleration f o r c e s w h i c h o c c u r at the m o m e n t o f i n j u r y . A c c e l e r a t i o n o f the s k u l l p r o d u c e s shearing a n d tearing o f n e u r a l tissue c o r t i c a l l y a n d subcortically.  D i r e c t i m p a c t f o r c e s p r o d u c e c o n t u s i o n s o f the b r a i n surface w h i c h m a y  appear at the p o i n t s o f i m p a c t o r i n areas r e m o t e f r o m this p o i n t as the b r a i n c o m e s into  1  contact with the bony surface of the skull.  Secondary brain injuries are not uncommon  and include subdural or epidural haematomas, intracerebral haemorrhages, cerebral edema leading to occlusion of cerebral blood vessels and compression of brain stem structures, and infection. Head injury often produces immediate loss of consciousness.  A period of  confusion and anterograde amnesia usually follow emergence from coma. Recovery of language functions is determined in part by the location, nature and severity of brain injury. It is essential to obtain relevant neurophysiological data in the assessment and treatment of aphasia following closed head injury. Studies of recovery of speech and language abilities in children after closed head injury have yielded differing clinical pictures.  One of these differences involves the impairment  and recovery of auditory comprehension. The current head injury research literature on this subject is difficult to interpret due to differences in etiology of subjects' brain injuries and testing procedures across studies.  Methods used to test comprehension have often yielded  only gross measures of abilities. Few studies have reached conclusions about the nature of syntactic comprehension abilities among head injured children. Most investigations which do address comprehension have used tests which either allow interpretation of sentences based on pragmatic or semantic knowledge or which are confounded by demands of shortterm memory. The purpose of this investigation was to examine comprehension of oral language by children who had suffered external head trauma, after spontaneous recovery had occurred. The study focused on the children's ability to assign thematic roles to noun phrases in sentences of varying complexity.  The following questions were addressed:  1. Is the assignment of thematic role more difficult in some sentence structures than in others for closed head injured and normal children? 2.  Do CHI children have more difficulty assigning thematic role than do normal children?  2  3.  A r e a n y p a r t i c u l a r sentence types r e l a t i v e l y m o r e susceptible to interpretation b r e a k d o w n than other sentence types i n the y o u n g C H I p o p u l a t i o n ?  4.  D o e s the pattern o f sentence interpretation b r e a k d o w n i n C H I c h i l d r e n r e s e m b l e  that  f o u n d i n C H I adults a n d aphasic adults? A n s w e r s to the a b o v e questions m a y p r o v i d e i n f o r m a t i o n about strategies that head i n j u r e d c h i l d r e n use to m a k e syntactic interpretations.  A p h a s i a i n A d u l t s after C l o s e d H e a d Injury Investigations o f speech a n d language after c l o s e d h e a d i n j u r y i n adults h a v e d i s c l o s e d a b r o a d range o f l a n g u a g e defects, i n c l u d i n g r e d u c e d w o r d f l u e n c y , a n o m i a , v e r b a l paraphasias, a n d d i s o r d e r s o f r e a d i n g a n d w r i t i n g .  C o g n i t i v e , attentional, b e h a v i o u r i a l a n d  m e m o r y d e f i c i t s c o e x i s t to p r o d u c e a c o m p l e x c l i n i c a l p i c t u r e that i s n o t t y p i c a l o f the classical aphasia syndromes.  T h o m s e n (1976) r e f e r r e d to the l a n g u a g e d i s o r d e r f o l l o w i n g  c l o s e d h e a d i n j u r y as " m u l t i s y m p t o m a t i c a p h a s i a . " E a r l y studies o f the h e a d - i n j u r e d p o p u l a t i o n ( A r s e n i , C o n s t a n t i n o v i c i , I l i e s c u , D o b r o t a , a n d G a g e a , 1970; R u s s e l l , 1932; L e w i n , 1966; H o o p e r , 1969) r e p o r t e d an i n i t i a l p e r i o d o f complete breakdown o f language abilities.  C o g n i t i v e i m p a i r m e n t s w e r e often r e p o r t e d , w i t h  decreased s h o r t - t e r m m e m o r y a n d attention span c o n s i d e r e d the p r i m a r y areas o f d e f i c i t . H o w e v e r , these e a r l y studies h a d the p u r p o s e o f e x a m i n i n g the c o u r s e o f r e c o v e r y i n g e n e r a l i n the c l o s e d head i n j u r e d p o p u l a t i o n a n d d i d n o t f o c u s o n language a b i l i t i e s i n particular.  W h i l e speech a n d language a b i l i t i e s w e r e u s u a l l y c o n s i d e r e d , e v a l u a t i o n o f  these f u n c t i o n s w a s u s u a l l y c u r s o r y a n d general i n nature.  H o w e v e r , several recent studies  o f the h e a d i n j u r e d p o p u l a t i o n have f o c u s e d o n language a n d speech i m p a i r m e n t s . T h o m s e n (1975) c o n d u c t e d a l o n g t e r m study o f t w e l v e c l o s e d h e a d i n j u r e d patients w i t h a m e a n age o f 2 5 1/2 years, w h o w e r e u n c o n s c i o u s at the t i m e o f i n j u r y a n d w h o h a d  3  s y m p t o m s o f aphasia f o u r m o n t h s p o s t i n j u r y .  O n e x a m i n a t i o n t w e l v e to fifty m o n t h s  p o s t i n j u r y , f o u r o f the t w e l v e patients h a d n o s y m p t o m s o f aphasia.  However, linguistic  a n a l y s i s o f spontaneous speech r e v e a l e d aphasic traits i n o n e o f these patients a n d i m p a i r m e n t o f v e r b a l l e a r n i n g i n the three others.  A m o n g the aphasic patients, the m o s t  frequent s y m p t o m s w e r e a n o m i a , v e r b a l p a r a p h a s i a , a g r a p h i a , a n d p e r s e v e r a t i o n .  Thomsen  n o t e d a r e s i d u a l d e c l i n e i n such c o m p l e x v e r b a l s k i l l s as d e t a i l e d v e r b a l d e s c r i p t i o n a n d the use o f a n t o n y m s , s y n o n y m s , a n d m e t a p h o r s .  I n a s e c o n d i n v e s t i g a t i o n i n w h i c h patients  w e r e tested at least o n e y e a r after i n j u r y , there w a s a n o v e r a l l t r e n d o f i m p r o v e m e n t . N o n e h a d i m p a i r e d c o m p r e h e n s i o n o f speech, as tested.  H o w e v e r , T h o m s e n d i d not  i d e n t i f y o r d e s c r i b e the tests o f c o m p r e h e n s i o n o f s p o k e n language e m p l o y e d i n h e r study. G r o h e r (1977) d o c u m e n t e d the m e m o r y a n d language s k i l l s o f fourteen patients w i t h a m e a n age o f 31 years w h o h a d s u f f e r e d c l o s e d h e a d trauma. H e r e p o r t e d p r o g r e s s i v e improvement over a four month period.  A t f o u r m o n t h s p o s t i n j u r y , n a m i n g to  c o n f r o n t a t i o n h a d r e c o v e r e d to n o r m a l l e v e l s i n a l l patients.  O f n i n e patients w h o i n i t i a l l y  h a d e x h i b i t e d spastic d y s a r t h r i a , s i x demonstrated n o r m a l a r t i c u l a t i o n .  T h e language skills  o f a l l patients w e r e adequate f o r c o n v e r s a t i o n a l purposes a l t h o u g h G r o h e r n o t e d that " n i n e o f the f o u r t e e n patients c a r r i e d o n c o n v e r s a t i o n s w h i c h w e r e i n a p p r o p r i a t e i n l e n g t h , a n d their t h o u g h t content w a s often c o n f u s e d a n d s e l d o m relevant to the d i s c u s s i o n " (p.218). N a m i n g to c o n f r o n t a t i o n , w h i c h w a s i n i t i a l l y i m p a i r e d i n a l l subjects, r e c o v e r e d c o m p l e t e l y . O r t h o g r a p h i c l a n g u a g e s k i l l s w e r e c h a r a c t e r i z e d b y errors i n s p e l l i n g , i n c o m p l e t e sentence c o n s t r u c t i o n a n d errors o f syntax.  G r o h e r e m p h a s i z e d that patients w h o d i s p l a y a  s e e m i n g l y " n o r m a l " a b i l i t y t o c o m m u n i c a t e m a y h a v e p e r s i s t i n g i n a b i l i t y to use a u d i t o r y i n f o r m a t i o n i n p r o b l e m s o l v i n g tasks. S a r n o (1980) e x a m i n e d the v e r b a l b e h a v i o u r referred to a r e h a b i l i t a t i o n m e d i c i n e centre.  o f f i f t y - s i x c l o s e d h e a d i n j u r e d patients  T h e f o l l o w i n g f o u r subtests o f the  4  N e u r o s e n s o r y C e n t e r C o m p r e h e n s i v e E x a m i n a t i o n f o r A p h a s i a ( N C C E A ) were a d m i n i s t e r e d about seven m o n t h s p o s t i n j u r y : V i s u a l N a m i n g , W o r d F l u e n c y , S e n t e n c e R e p e t i t i o n , a n d the T o k e n Test.  A f t e r testing, patients w e r e c l a s s i f i e d i n t o three d i a g n o s t i c categories:  aphasic, b) d y s a r t h r i c w i t h s u b c l i n i c a l aphasic d i s o r d e r a n d c) s u b c l i n i c a l a p h a s i a g r o u p s s h o w e d s o m e degree o f aphasic i m p a i r m e n t , w i t h c l i n i c a l l y aphasic  a) All  1  patients  representing the m o s t severe, d y s a r t h r i c s intermediate a n d the s u b c l i n i c a l g r o u p the m i l d e s t . C o n s i s t e n t w i t h T h o m s e n ' s f i n d i n g , S a r n o reported that a l l patients h a d either a language disorder or dysarthria, or both.  E v e n the m i l d e s t g r o u p , the s u b c l i n i c a l c a t e g o r y ,  as s i g n i f i c a n t l y i m p a i r e d o n a l l f o u r subtests.  emerged  S a m o c o n c l u d e d the "the use o f  sophisticated, n e u r o l i n g u i s t i c measures w i t h [the h e a d injured] p o p u l a t i o n is n e e d e d to detect subtle d e f i c i t s " (p.  691).  H e i l m a n , S a g r a n , a n d G e s c h w i n d (1971) s t u d i e d the v e r b a l a b i l i t i e s o f thirteen c l o s e d h e a d i n j u r e d patients w i t h a m e a n age o f 57 years w h o s h o w e d s y m p t o m s o f aphasia. Patients w e r e tested w h e n alert a n d c o - o p e r a t i v e after r e g a i n i n g c o n s c i o u s n e s s .  Nine  patients w e r e c l a s s i f i e d as h a v i n g a n o m i c aphasia a n d f o u r as h a v i n g W e r n i c k e ' s aphasia. S i x out o f the n i n e patients w i t h a n o m i c aphasia h a d some a d d i t i o n a l defect o f h i g h e r cortical function, i n c l u d i n g right-left confusion, finger agnosia, dyscalculia, dysgraphia, and dyslexia.  U n f o r t u n a t e l y , the e x a m i n e r s w e r e not able to investigate p a t i e n t s ' progress o v e r  the l o n g t e r m . L e v i n , G r o s s m a n , S a r w a r a n d M e y e r s (1981) studied the r e c o v e r y o f language o v e r s e v e r a l years i n t w e n t y - o n e aphasic C H I patients d u r i n g i n i t i a l h o s p i t a l i z a t i o n . range o f patients w a s between 17 a n d 5 0 years, w i t h a m e d i a n age o f 2 2 years.  T h e age The  f o l l o w i n g subtests o f the M u l t i l i n g u a l A p h a s i a E x a m i n a t i o n ( M A E ) w e r e a d m i n i s t e r e d :  'The term "subclinical aphasia" refers to language which has recovered to normal levels in almost all areas, but which contains persisting specific defects such as anomia or word finding difficulties. 5  V i s u a l N a m i n g , Sentence R e p e t i t i o n , C o n t r o l l e d W o r d A s s o c i a t i o n , T o k e n Test, A u d i t o r y C o m p r e h e n s i o n o f W o r d s a n d Phrases, a n d R e a d i n g C o m p r e h e n s i o n . R e s u l t s i n d i c a t e d that s i x patients h a d a s p e c i f i c l i n g u i s t i c disturbance i n w h i c h o n l y a single f u n c t i o n w a s i m p a i r e d , s i x patients h a d m o r e g e n e r a l i z e d l i n g u i s t i c d y s f u n c t i o n , a n d n i n e patients o b t a i n e d n o r m a l scores o n a l l tests. deficits was anomia.  T h e m o s t c o m m o n d e f i c i t a m o n g patients w i t h s p e c i f i c  N o n e o f these patients s h o w e d i m p a i r e d c o m p r e h e n s i o n .  Among  those w i t h g e n e r a l i z e d l i n g u i s t i c disturbance, a l l s h o w e d i m p a i r m e n t o f c o m p r e h e n s i o n o f oral language.  L e v i n a n d h i s c o w o r k e r s a l s o a n a l y z e d C T scan results i n r e l a t i o n to the  p r o f i l e o f l a n g u a g e , a n d f o u n d that persistent a n o m i a w i t h n o r m a l c o m p r e h e n s i o n after C H I w a s associated w i t h m i l d d i f f u s e b r a i n i n j u r y , w h i l e g e n e r a l i z e d l i n g u i s t i c d e f i c i t i n v o l v i n g b o t h p r o d u c t i o n a n d c o m p r e h e n s i o n f u n c t i o n s w a s related to severe d i f f u s e b r a i n d a m a g e and global cognitive deficit. B u t l e r - H i n z , C a p l a n , and Waters (unpublished manuscript) examined comprehension d e f i c i t s i n C H I adults a n d adult stroke patients.  A t o y a n i m a l m a n i p u l a t i o n task d e v e l o p e d  b y C a p l a n et a l . (1985) w a s a d m i n i s t e r e d to thirty E n g l i s h a n d t h i r t y F r e n c h s p e a k i n g individuals.  T e n subjects i n e a c h g r o u p h a d suffered c l o s e d h e a d i n j u r i e s .  A g e s ranged  f r o m 16 to 57 years a n d a l l patients w e r e tested at least t w o m o n t h s p o s t i n j u r y . C o m p r e h e n s i o n d e f i c i t s w e r e f o u n d i n a l l C H I subjects.  F u r t h e r m o r e , patterns o f  c o m p r e h e n s i o n b r e a k d o w n w e r e evident a n d w e r e s i m i l a r to the patterns o f b r e a k d o w n seen a m o n g adult stroke patients.  T h e s e patterns were based o n the presence o f several  syntactic features i d e n t i f i e d b y the authors.  A p h a s i a i n C h i l d r e n after C l o s e d H e a d Injury Studies that h a v e e x a m i n e d l i n g u i s t i c d e f i c i t s i n c h i l d r e n w i t h b r a i n i n j u r y h a v e u s u a l l y i n c l u d e d subjects w i t h v a r y i n g e t i o l o g y a n d severity o f i n j u r y .  6  G u t t m a n ' s (1942)  review  w a s the earliest c o m p r e h e n s i v e e x a m i n a t i o n o f the s y m p t o m a t o l o g y a n d r e c o v e r y o f c h i l d h o o d aphasia.  I n a g r o u p o f thirty c h i l d r e n aged 2 to 14 years that i n c l u d e d n i n e  cases o f h e a d i n j u r y , G u t t m a n r e p o r t e d that sixteen patients w e r e a p h a s i c .  I n a l l o f these  cases, aphasia w a s c h a r a c t e r i z e d b y a r e d u c t i o n o f v e r b a l p r o d u c t i o n a n d s e e m i n g l y spared c o m p r e h e n s i o n . R e c o v e r y o f l a n g u a g e w a s r a p i d , but speech w a s m a r k e d b y hesitancy a n d dysarthria.  Patients g e n e r a l l y d i d not e x h i b i t o b v i o u s paraphasic errors.  G u t t m a n (1942)  o b s e r v e d that the pattern o f l i n g u i s t i c d e f i c i t w a s at least p a r t i a l l y age dependent.  In  patients u n d e r age 10, l e s i o n s i n the c o r t i c a l areas b e l i e v e d to be r e s p o n s i b l e f o r language r e s u l t e d i n a r e d u c t i o n o f spontaneous speech.  I n patients 10 years a n d o l d e r , speech w a s  u s u a l l y f l u e n t , a n d the pattern o f aphasia m o r e c l o s e l y r e s e m b l e d that o f aphasic adults. A l a j o u a n i n e a n d L h e r m i t t e (1965) s t u d i e d t h i r t y - t w o aphasic c h i l d r e n b e t w e e n 6 a n d 15 years o l d w i t h left h e m i s p h e r e l e s i o n s , i n c l u d i n g thirteen cases w i t h h e a d i n j u r y .  The  c h i l d r e n w e r e s t u d i e d o v e r several years, w i t h the first e x a m i n a t i o n t a k i n g p l a c e w i t h i n an average o f three m o n t h s p o s t i n j u r y .  Tests p e r f o r m e d i n c l u d e d the W e c h s l e r f o r c h i l d r e n  ( W I S C ) o r W e c h s l e r - B e l l e v u e , a c c o r d i n g to age, B e n d e r ' s a n d R e y ' s * T e r m a n - M e r r i l l , arrangement o f cubes ( K O H S ) a n d p r o g r e s s i v e m a t r i x ( P M 47).  Consistent w i t h Guttman's  f i n d i n g s , the authors r e p o r t e d a r e d u c t i o n o f e x p r e s s i o n , i n c l u d i n g o r a l a n d w r i t t e n l a n g u a g e , a n d gestures.  D y s a r t h r i a o c c u r r e d i n t w e n t y - t w o patients, w i t h the features o f the  d y s a r t h r i a s i m i l a r to those f o u n d i n adults.  P r o d u c t i v e language w a s m a r k e d b y r e d u c e d  v o c a b u l a r y a n d s i m p l i f i e d s y n t a x , but a g r a m m a t i s m w a s not present.  I n contrast to aphasia  i n adults, the authors f o u n d that l o g o r r h e a a n d perseveration d i d not o c c u r a n d p h o n e m i c a n d semantic paraphasias w e r e v e r y rare. of oral comprehension.  T e n o f the t h i r t y - t w o patients s h o w e d disorders  A m o n g those u n d e r 10 years o f age, u n d e r s t a n d i n g o f s p o k e n  l a n g u a g e w a s a l m o s t a l w a y s i m p a i r e d (eight out o f n i n e c h i l d r e n ) .  Recovery of auditory  c o m p r e h e n s i o n w a s r a p i d , h a v i n g r e s o l v e d to near n o r m a l l e v e l s b y s i x m o n t h s after onset  7  o f aphasia.  W h e n the c h i l d r e n w e r e c o m p a r e d b y age l e v e l , i t w a s f o u n d that f o r those  u n d e r 10 years o f age the r e d u c t i o n o f v e r b a l e x p r e s s i o n w a s m o r e severe a n d disorders o f a r t i c u l a t i o n w e r e m o r e frequent than f o r o l d e r c h i l d r e n .  F o l l o w - u p e x a m i n a t i o n s at six  m o n t h s after onset o f aphasia r e v e a l e d n o r m a l speech i n s i x out o f t w e n t y - t w o c h i l d r e n . A m o n g the r e m a i n i n g sixteen, w o r d - f i n d i n g , a g r a m m a t i s m , a n d a r t i c u l a t i o n p r o b l e m s remained.  T h e r e w e r e a l s o d i f f i c u l t i e s w i t h h i g h e r l e v e l language f u n c t i o n s ( d e s c r i p t i o n ,  narration, definition of words).  S e v e r e a l e x i a r e m a i n e d i n h a l f o f the subjects.  A f t e r one  year p o s t i n j u r y , t w e n t y - t w o o f the t h i r t y - t w o c h i l d r e n h a d r e g a i n e d n o r m a l o r n e a r l y n o r m a l language.  F o u r t e e n h a d subtle alterations o f language o n tests o f n a r r a t i o n , c o n s t r u c t i o n o f  sentences a n d d e f i n i t i o n o f w o r d s .  T h e authors c o n c l u d e d that the extent o f r e c o v e r y f r o m  a p h a s i a a m o n g c h i l d r e n is greater than a m o n g adult aphasics. T h e y attributed this r e c o v e r y to the n e u r a l p l a s t i c i t y o f the y o u n g c h i l d ' s b r a i n . H e c a e n (1976) studied the v e r b a l abilities o f t w e n t y - t w o c h i l d r e n , 3 1/2 to 15 years o f age, w i t h c o r t i c a l l e s i o n s ; sixteen o f the c h i l d r e n w e r e C H I patients.  Test methodology  w a s not d i s c u s s e d but l i k e l y i n c l u d e d standardized tests o f language f u n c t i o n .  Nineteen  c h i l d r e n w e r e f o u n d to be aphasic, i n c l u d i n g 8 8 % o f the cases w i t h left h e m i s p h e r e l e s i o n a n d 3 2 % o f the c h i l d r e n w i t h r i g h t h e m i s p h e r e l e s i o n .  Hecaen noted t w o  characteristics  w h i c h w e r e consistent w i t h the f i n d i n g s o f p r e v i o u s studies: frequent m u t i s m a n d rare, i f not absent, p a r a p h a s i a .  A r t i c u l a t o r y disorders w e r e  frequent.  c o m p r e h e n s i o n appeared i n m o r e than a t h i r d o f the cases.  Disorders of auditory verbal T h e s e f i n d i n g s are i n  agreement w i t h those o f A l a j o u a n i n e a n d L h e r m i t t e (1965) but i n c o n t r a d i c t i o n to G u t t m a n (1942) o r B r a n c o - L e f e v r e (1950), w h o stated that a u d i t o r y c o m p r e h e n s i o n p r o b l e m s w e r e rare i n c h i l d h o o d aphasia.  A l s o i n agreement w i t h A l a j o u a n i n e a n d L h e r m i t t e , H e c a e n  n o t e d that c o m p r e h e n s i o n d i f f i c u l t i e s o c c u r r e d o n l y i n the acute p e r i o d , w i t h r a p i d a n d c o m p l e t e r e c o v e r y o f this f u n c t i o n .  H e also n o t e d that this d e f i c i t o n l y o c c u r r e d i n  8  children with temporal lobe lesions. Alexia resolved rapidly while disorders of writing 2  were the most common symptom during the acute period and the least likely to resolve. Acalculia was very frequent. Hecaen noted that, "although recovery is certainly more 3  striking than in the adult, it is important to stress the persistence, at times permanently, of mild verbal deficits" (p. 125). In a later investigation, Hecaen (1983) reexamined the twenty-six earlier cases along with thirty new cases. Etiology of subjects was mixed, and included twelve traumatically closed head injuries. Thirty-four children were right-handed and had left sided lesions. Of these, twenty-three showed symptoms of aphasia. The frequency of aphasia in children under 10 years was greater than for older children. As in his earlier study, Hecaen found that mutism was the predominant clinical symptom. Furthermore, he found that the incidence of mutism was far greater with acute head injury (85%), than with progressive lesions (20%). Dysarthria was found in 52% of cases, and was more common among younger children, head injured children, and those with anterior lesions. As in his earlier study, Hecaen found that disorders of auditory comprehension were quite frequent, occurring in more than one-third of the cases but resolved rapidly and completely. In agreement with Alajouanine and Lhermitte, Hecaen found that logorrhea was absent and verbal paraphasias were rare. Word rinding difficulties were frequent and tended to persist. Alexia was common in the early stages but usually disappeared quickly. Anteriorly located lesions were associated  with more disturbance of all aspects of language, including  ^The prefix "a-" denotes an absence. Hence, "alexia" means inability to read. The prefix "dys-" conveys the idea of a reduction. "Dyslexia" thus means a level of reading which is less ihan expected. In clinical and research literature, these prefixes are often used interchangeably. Inability to use mathematical symbols.  3  9  a u d i t o r y a n d v i s u a l v e r b a l c o m p r e h e n s i o n , than t e m p o r a l l o c a t e d l e s i o n s .  Persistence  of  aphasic s y m p t o m s appeared to be l i n k e d to the s i z e o r b i l a t e r a l i t y o f the l e s i o n s . L e v i n a n d E i s e n b e r g (1979) a d m i n i s t e r e d the N C C E A to s i x t y - f o u r c h i l d r e n a n d adolescents w h o sustained b l u n t trauma to the head. percent o f the cases.  L i n g u i s t i c defects w e r e f o u n d i n 3 1 %  A n o m i a w a s the m o s t p r o m i n e n t d e f i c i t .  tested w i t h the T o k e n T e s t w a s affected i n 1 1 % o f the cases. affected.  O r a l c o m p r e h e n s i o n as V e r b a l r e p e t i t i o n w a s least  N e a r l y h a l f o f the cases e x h i b i t e d i m p a i r e d v e r b a l l e a r n i n g a n d m e m o r y .  The  authors c o n c l u d e d that " s u b c l i n i c a l language d i s o r d e r o c c u r s after C H I i n c h i l d r e n w i t h a f r e q u e n c y c o m p a r a b l e to that f o u n d i n a d u l t s " ( L e v i n , 1981, p .  454).  S p e e c h a n d language a b i l i t i e s o f eight C H I c h i l d r e n w h o h a d passed the r e c o v e r y p e r i o d w e r e i n v e s t i g a t e d b y M i t c h e l l (1985). administered.  spontaneous  A series o f standardized tests were  T h e s e i n c l u d e d : T h e P e a b o d y P i c t u r e V o c a b u l a r y Test, the T o k e n Test, the  A u d i t o r y C o m p r e h e n s i o n T e s t f o r Sentences, a n d the C l i n i c a l E v a l u a t i o n o f L a n g u a g e F u n c t i o n s - P r o d u c t i o n subtests.  T h e language o f C H I c h i l d r e n w a s c h a r a c t e r i z e d b y r e d u c e d  a u d i t o r y c o m p r e h e n s i o n , perseveration, w o r d - f i n d i n g d i f f i c u l t i e s a n d s e q u e n c i n g p r o b l e m s . M e a s u r e s o f a u d i t o r y c o m p r e h e n s i o n s h o w e d r e d u c e d retention o f l i n g u i s t i c d e t a i l , perhaps d u e to l i m i t a t i o n s o f m e m o r y .  P r o d u c t i v e syntax w a s intact f o r a l l subjects.  Mitchell  c o n c l u d e d that d e f i c i t s o b s e r v e d i n c o m p r e h e n s i o n a n d p r o d u c t i o n w e r e l e x i c a l l y rather than s y n t a c t i c a l l y b a s e d a n d suggested that syntax " i s a r o b u s t p h e n o m e n o n w h i c h is h i g h l y resistant to d i s r u p t i o n " (p. 62). H v o z d a n s k i (1986) investigated w o r d - f i n d i n g a b i l i t i e s o f f i v e o f the subjects studied b y Mitchell.  S h e f o u n d that results w e r e d e t e r m i n e d i n part b y test m e t h o d o l o g y .  Subjects  w h o r e c e i v e d scores w i t h i n the n o r m a l range o n s t a n d a r d i z e d tests s u c h as the B o s t o n N a m i n g T e s t c o u l d e x h i b i t a n a m i n g d e f i c i t i n c o n v e r s a t i o n a l speech.  C l o s e d head injured  subjects also p r o d u c e d s i m p l i f i e d language m a r k e d b y r e d u c e d m e a n l e n g t h o f  ( 10  (  utterance  a n d s i m p l i f i e d syntax.  T h e language o f h e a d i n j u r e d c h i l d r e n i n c l u d e d m o r e hesitations  a n d pauses, w h i c h H v o z d a n s k i interpreted as i n d i c a t i v e o f w o r d - f i n d i n g d i f f i c u l t i e s . M e t a l i n g u i s t i c s k i l l s (e.g. a n t o n y m s , h o m o n y m s , metaphors) w e r e a l s o r e d u c e d i n the h e a d injured population. T h e s e studies y i e l d several features i n c o m m o n w i t h respect to the c l i n i c a l picture o f c h i l d h o o d v e r s u s adult aphasia f o l l o w i n g c l o s e d h e a d i n j u r y .  S o m e o f the p r o p o s e d  d i f f e r e n c e s are as f o l l o w s :  1)  A c q u i r e d aphasia p r o d u c e d b y C H I i n c h i l d r e n i s c h a r a c t e r i z e d b y a r e d u c t i o n i n output, h e s i t a n c y , f a i l u r e to initiate speech, a n d p o s s i b l y m u t i s m , w h i l e n o n f l u e n t e x p r e s s i v e a p h a s i a i s r a r e l y f o u n d i n adults w i t h C H I ( G u t t m a n , 1942; H e c a e n , 1976; A l a j o u a n i n e a n d L h e r m i t t e , 1965).  2)  C h i l d r e n r a r e l y e x h i b i t o b v i o u s paraphasic errors, j a r g o n , o r perseveration ( G u t t m a n , 1942;  A l a j o u a n i n e a n d L h e r m i t t e , 1965).  D e s p i t e these s i m i l a r i t i e s , differences i n the c l i n i c a l p i c t u r e o f c h i l d h o o d aphasia s t i l l exist across studies.  O n e p r o m i n e n t i n c o n s i s t e n c y concerns a u d i t o r y c o m p r e h e n s i o n .  s o m e studies h a v e suggested that auditory  While  c o m p r e h e n s i o n d e f i c i t s are rare i n c h i l d h o o d  a p h a s i a ( G u t t m a n , 1942; B r a n c o - L e f e v r e , 1950), others report frequent c o m p r e h e n s i o n d e f i c i t s i n at least the acute p e r i o d ( H e c a e n , 1976; A l a j o u a n i n e a n d L h e r m i t t e , 1965; a n d E i s e n b e r g , 1979).  Levin  T h e s e studies suggest the presence o f a u d i t o r y c o m p r e h e n s i o n  d e f i c i t s f o l l o w i n g C H I but are not i n d i c a t i v e o f the r o l e that syntactic structure p l a y s i n aural sentence c o m p r e h e n s i o n f o l l o w i n g b r a i n trauma.  11  Disorders o f Syntactic Comprehension I n order to m a k e a quantitative assessment o f aphasia i n C F f l patients, researchers a n d clinicians have 1967)  frequently  u s e d the M u l t i l i n g u a l A p h a s i a E x a m i n a t i o n ( M A E ) ( B e n t o n ,  a n d the N e u r o s e n s o r y C e n t e r C o m p r e h e n s i v e E x a m i n a t i o n o f A p h a s i a ( N C C E A )  (Spreen a n d B e n t o n , 1969). a n d V i g n o l o , 1962)  B o t h o f these test batteries i n c l u d e the T o k e n T e s t ( D e R e n z i  to evaluate c o m p r e h e n s i o n o f o r a l sentences.  T h e T o k e n T e s t consists  o f o r a l c o m m a n d s o r g a n i z e d i n sections o r d e r e d b y i n c r e a s i n g l e n g t h a n d syntactic complexity.  T e s t subjects are r e q u i r e d to m a n i p u l a t e c o l o u r e d g e o m e t r i c f o r m s i n response  to the c o m m a n d s .  T h e a b i l i t y to attribute m o d i f i c a t i o n , assign thematic roles a n d  t e m p o r a l l y order actions i s assessed t h r o u g h the presentation o f v a r i o u s syntactic of increasing length and complexity.  structures  W h i l e the T o k e n T e s t has p r o v e d to be u s e f u l i n  d i s t i n g u i s h i n g patients c o n s i d e r e d aphasic f r o m n o r m a l subjects, its usefulness as a test o f the syntactic interpretation o f sentences has been q u e s t i o n e d . s e v e r a l l i m i t a t i o n s o f the test.  C a p l a n (1987) o u t l i n e d  F i r s t , the T o k e n T e s t m a k e s i n c r e a s i n g d e m a n d s o n m e m o r y  as syntactic d e m a n d s increase (Lesser, 1976).  S i n c e short-term m e m o r y i m p a i r m e n t is  c o m m o n a m o n g C H I patients, errors cannot be r e l i a b l y attributed to d e f i c i t s o f syntactic comprehension.  S e c o n d , T o k e n T e s t scores are not arranged b y syntactic  structure.  T h e r e f o r e results are not r e v e a l i n g w i t h respect to s p e c i f i c structures w h i c h are d i f f i c u l t f o r patients to interpret.  T h i r d , the T o k e n T e s t i n c l u d e s sentences c o n t a i n i n g subordinate  t e m p o r a l c o n j u n c t i o n s (before, after, u n t i l ) .  Patients m a y r e s p o n d i n c o r r e c t l y to these  sentences, not because o f an i m p a i r m e n t o f syntactic c o m p r e h e n s i o n , but because they l a c k k n o w l e d g e o f a w o r d ' s m e a n i n g o r because the a c t i o n r e q u i r e d is o p p o s i t e to the s p o k e n o r d e r o f clauses i n the test i t e m .  C a p l a n states "the experience w i t h the T T , t h o u g h  v a l u a b l e i n the i d e n t i f i c a t i o n o f aphasic patients, does not c l e a r l y l e a d to hypotheses  12  r e g a r d i n g the syntactic structures w h i c h are assigned a n d interpreted i n a p h a s i a " ( C a p l a n et a l . , 1975). C a p l a n a n d h i s c o w o r k e r s (1985) d e v e l o p e d a test battery to investigate the syntactic determinates o f sentence c o m p r e h e n s i o n . presented o r a l l y .  T h e battery consists o f f o r t y - f i v e sentences  I n this task, subjects are r e q u i r e d to demonstrate their u n d e r s t a n d i n g o f  the thematic r o l e s o f the n o u n s i n the sentences b y m a n i p u l a t i n g t o y a n i m a l s p l a c e d i n front o f t h e m . rmnimized.  T h e r o l e s o f short-term m e m o r y a n d m o t o r - p e r c e p t u a l factors  are  I n their study o f three g r o u p s o f adult stroke patients, the authors f o u n d that  syntactic structure h a d a s i g n i f i c a n t effect u p o n correct interpretation o f sentences. F u r t h e r m o r e , s i m i l a r patterns o f c o m p r e h e n s i o n b r e a k d o w n across sentence types o c c u r r e d across patient p o p u l a t i o n s . C a p l a n a n d h i s c o l l e a g u e s i d e n t i f i e d three "elementary structural features"  which  p a r t i a l l y d e t e r m i n e d the c o m p l e x i t y o f sentences f o r the aphasic p o p u l a t i o n : the presence o f a n o n c a n o n i c a l thematic r o l e order, a t h i r d thematic r o l e , o r a s e c o n d v e r b .  The  c o m p l e x i t y o f the sentence interpretation task c o u l d be p r e d i c t e d i n part b y the n u m b e r o f structural features a sentence c o n t a i n e d . I n a case study i n v e s t i g a t i n g sentence c o m p r e h e n s i o n b y an a g r a m m a t i c adult patient, C a p l a n a n d F u t t e r (1986) suggested that a s i m p l e l i n e a r o r d e r strategy w a s u s e d b y thensubject to a s s i g n thematic r o l e s .  T h i s strategy v i o l a t e s the set o f r u l e s o f E n g l i s h sentence  structure, w h i c h are b a s e d o n a h i e r a r c h i c a l structure o f syntactic categories.  The  strategy  u s e d b y C a p l a n a n d F u t t e r ' s subject therefore l e d to m i s i n t e r p r e t a t i o n o f several sentence types. B u t l e r - H i n z , C a p l a n , a n d W a t e r s ( u n p u b l i s h e d m a n u s c r i p t ) a d m i n i s t e r e d the t o y - a n i m a l m a n i p u l a t i o n p r o c e d u r e d e s c r i b e d a b o v e to e x a m i n e the characteristics o f syntactic c o m p r e h e n s i o n d e f i c i t s i n adults f o l l o w i n g c l o s e d h e a d i n j u r i e s a n d strokes.  13  T h e pattern o f  c o m p r e h e n s i o n b r e a k d o w n i n these p o p u l a t i o n s w a s s i m i l a r to that f o u n d a m o n g aphasic adults ( C a p l a n et a l . , 1985).  Experimental Hypotheses T h e research questions that emerge f r o m the studies r e v i e w e d (see p . 3), stated as n u l l hypotheses, are: 1.  T h e degree o f thematic r o l e assignment d i f f i c u l t y i s not dependent o n sentence structure f o r either c l o s e d h e a d i n j u r e d o r n o r m a l c h i l d r e n .  2.  T h e r e i s n o d i f f e r e n c e i n c l o s e d h e a d i n j u r e d a n d n o r m a l c h i l d r e n ' s a b i l i t y to assign thematic r o l e s i n sentences.  3.  T h e r e i s n o d i f f e r e n c e i n s u s c e p t i b i l i t y o f v a r i o u s sentence types to interpretation b r e a k d o w n i n the y o u n g c l o s e d h e a d i n j u r e d p o p u l a t i o n .  14  CHAPTER  2  METHOD  Procedure T h e present i n v e s t i g a t i o n f o c u s e d o n the a b i l i t y o f c l o s e d - h e a d i n j u r e d ( C H I ) c h i l d r e n to c o m p r e h e n d the assignment o f thematic roles to n o u n s .  T h e p r o c e d u r e i n v o l v e d the use o f  an object m a n i p u l a t i o n p r o t o c o l o r i g i n a l l y adopted f r o m language d e v e l o p m e n t research a n d u s e d b y C a p l a n , B a k e r a n d D e h a u t (1985).  T h i s technique r e q u i r e s that subjects  first  attend to a sentence presented a u d i t o r i a l l y , a n d then demonstrate their u n d e r s t a n d i n g o f the sentence b y m a n i p u l a t i n g t o y a n i m a l s .  T h i s technique has been s h o w n to a l l o w patients'  patterns o f syntactic c o m p r e h e n s i o n to be s t u d i e d independent o f extraneous v a r i a b l e s such as s p a t i a l preference strategies, m a n i p u l a t i o n preference strategies, a n d l e x i c a l p r a g m a t i c effects ( C a p l a n et a l . , 1985). S t i m u l i c o n s i s t e d of: (i) active a n d p a s s i v e sentences, (ii) cleft sentences o n the subjects a n d objects, (iii) a c t i v e a n d p a s s i v e d a t i v e c o n s t r u c t i o n s , (iv) c o m p l e x sentences w i t h r e l a t i v e a n d c o n j o i n e d clauses. is g i v e n i n T a b l e 1.  A n e x a m p l e o f e a c h sentence type  F i v e instances o f e a c h t y p e o f sentence w e r e presented.  T e s t i n g sessions w e r e s i m i l a r to those o u t l i n e d b y C a p l a n et a l . (1985). T h e y began w i t h b r i e f c o n v e r s a t i o n s w i t h e a c h subject a n d an e x p l a n a t i o n o f the testing p r o c e d u r e . E x p l a n a t i o n s w e r e not s t a n d a r d i z e d . R a t h e r , they w e r e m o d i f i e d as n e e d e d to m a k e the task c l e a r to e a c h p a r t i c i p a n t , as c o m p r e h e n s i o n abilities o f the subjects w e r e v a r i a b l e . m e m o r y pretest h a d d e t e r m i n e d that each subject c o u l d i d e n t i f y the a n i m a l s i n the  15  A  T a b l e 1.  Sentence T y p e s T e s t e d w i t h T h e m a t i c R o l e B a t t e r y  Type  Example  1.  Active (A)  T h e m o n k e y patted the rabbit.  2.  P a s s i v e (P)  T h e m o n k e y w a s t o u c h e d b y the rabbit.  3.  Cleft-subject  4.  Cleft-object  5.  Dative (D)  6.  D a t i v e p a s s i v e ( D P ) T h e m o n k e y w a s brought to the turtle b y the elephant.  7.  Conjoined (C)  8.  S u b j e c t - o b j e c t r e l a t i v e (SO)  9.  Object-subject  (CS)  It w a s the m o n k e y that h u g g e d the goat.  (CO)  It w a s the rabbit that the m o n k e y k i s s e d . T h e m o n k e y sent the rabbit to the turtle.  T h e goat bit the m o n k e y a n d caught the elephant. T h e elephant that the goat h u g g e d h i t the turtle.  r e l a t i v e ( O S ) T h e elephant scratched the r a b b i t that c a u g h t the turtle.  f o l l o w i n g arrays: 1 i t e m i n a 5 - i t e m array; 2 items i n a 2 - i t e m array; 3 i t e m s i n a 3 - i t e m array; 2 i t e m s i n a 6 - i t e m array; a n d 3 items i n a 6 - i t e m array. battery w a s then a d m i n i s t e r e d .  T h e a c t u a l 45-sentence  I n e a c h sentence, o n l y the a n i m a l s m e n t i o n e d i n the  sentence w e r e p l a c e d o n the table i n r a n d o m array. sentence a n d r e c o r d e d the subject's response.  T h e e x p e r i m e n t e r t h e n r e a d the  I n d i v i d u a l testing w a s c a r r i e d out at the h o m e s  o f the subjects u n d e r r o u g h l y e q u i v a l e n t c o n d i t i o n s .  Subjects S e v e n t r a u m a t i c a l l y c l o s e d - h e a d i n j u r e d c h i l d r e n w e r e selected a n d r e f e r r e d b y l a n g u a g e pathologists f r o m three r e h a b i l i t a t i o n centres i n the V a n c o u v e r area. f r o m 9 to 15 years.  T h e r e w e r e f o u r m a l e s a n d three f e m a l e s .  16  speech-  A g e s ranged  N o n e o f the subjects h a d a  history o f hearing impairment or learning disability. months  post-onset  a n d demonstrated  A l l patients w e r e tested at least t w o  s y m p t o m stabilization.  m a t c h e d i n d i v i d u a l l y to c o n t r o l c h i l d r e n b y age a n d sex.  Head-injured children  were  Table 2 summarizes information  about e a c h patient's age at testing, age at i n j u r y , sex, e t i o l o g y , a n d l e s i o n l o c a t i o n .  I n d i v i d u a l subject d e s c r i p t i o n s  Subject 1 - K P : K P sustained a severe h e a d i n j u r y i n a h i g h speed m o t o r v e h i c l e accident w h e n he w a s 11 years 11 m o n t h s o f age (11;11).  H e lost c o n s c i o u s n e s s i m m e d i a t e l y a n d , o n a d m i s s i o n  to h o s p i t a l , w a s f o u n d to h a v e a fracture o f the r i g h t f r o n t a l a n d p a r i e t a l s k u l l e x t e n d i n g to the base o f the s k u l l at the l e v e l o f the o r b i t a l roof.  T a b l e 2.  A C T scan r e v e a l e d b r a i n shift  from  Subject Descriptions A g e at Injury  A g e at Testing  Coma Duration  Lesion Localization  Subject  Sex  KP  M  11 y r s .  15 y r s .  10 d a y s  KT  F  2 yrs.  12 y r s .  4 days  left  KF  F  12 y r s .  13 y r s .  6 weeks  bilateral  KV  F  8 yrs.  9 yrs.  4 days  right  DT  M  12 y r s .  13 y r s .  < 7 days  WG  M  9 yrs.  11 yrs.  4.5 m o n t h s  bilateral  RB  M  12 yrs.  14 yrs.  3.5 m o n t h s  bilateral  17  bilateral  left  m i d l i n e to the left i n v o l v i n g the right lateral v e n t r i c l e s .  A m i l d d i l a t i o n o f the left lateral  v e n t r i c l e s a n d a h a e m a t o m a i n the r i g h t f r o n t a l p a r i e t a l area w e r e also evident. K P r e m a i n e d c o m a t o s e f o r ten d a y s .  O n the tenth d a y p o s t i n j u r y he w a s able to obey  s i m p l e c o m m a n d s . H e attempted to m o u t h e w o r d s but w a s unable to a c h i e v e p h o n a t i o n . w a s able to w r i t e h i s n a m e . evident.  Reflexes  He  w e r e intact but an o v e r a l l l e f t - s i d e d weakness  was  A t t w o w e e k s p o s t i n j u r y , K P w a s able to n o d his h e a d f o r " y e s " a n d p o i n t to objects  he w a n t e d .  B y the t h i r d w e e k p o s t i n j u r y , he r e s p o n d e d to s i m p l e questions w i t h o n e - w o r d  s p o k e n answers, but h i s v o i c e w a s o f l o w intensity. c o n s i s t e d o f o n e - a n d t w o - w o r d utterances. w e r e i n c o m p l e t e o r perseverative. sentences.  A t o n e m o n t h p o s t i n j u r y , K P ' s speech  S p e e c h w a s i m p r o v i n g r a p i d l y but m o s t utterances  W r i t t e n language c o n s i s t e d o f s i n g l e w o r d s a n d  A t t e n t i o n span a n d p e r c e p t u a l abilities w e r e l i m i t e d .  particularly weak. premorbid levels.  short  Short-term memory  A t t w o m o n t h s p o s t i n j u r y , language testing r e v e a l e d a b i l i t i e s close W o r d f i n d i n g d i f f i c u l t i e s w e r e s t i l l evident.  was to  C o g n i t i v e testing i n d i c a t e d  c o g n i t i v e a b i l i t i e s w e r e at age l e v e l but h i g h e r l e v e l f u n c t i o n s r e m a i n e d p r o b l e m a t i c .  A t three  m o n t h s p o s t i n j u r y , K P ' s language c o m p r e h e n s i o n s k i l l s as tested w e r e w i t h i n n o r m a l l i m i t s . Language  production was  conversational inappropriate.  situations.  below  age  level.  Spontaneous  W o r d rinding  speech  was  difficulties were  circumlocutory  and  evident  often  in  socially  A t seven m o n t h s p o s t i n j u r y , K P w a s attending r e g u l a r classes at s c h o o l f u l l t i m e  but r e q u i r e d t u t o r i n g i n a l l subjects, a n d m e m o r y lapses a n d w o r d - f i n d i n g d i f f i c u l t i e s w e r e still apparent.  A t the t i m e o f this study,  and no longer received tutoring.  K P w a s attending r e g u l a r h i g h s c h o o l classes f u l l t i m e  K P is a c t i v e i n c o m p e t i t i v e f i g u r e s k a t i n g w i t h h i s sister.  Subject 2 - K T : K T w a s struck b y a car w h i l e c r o s s i n g the street w h e n she w a s 2; 3. the left side o f the h e a d a n d rendered i m m e d i a t e l y u n c o n s c i o u s .  18  She w a s struck o n  S h e w a s a d m i t t e d to hospital  t w e n t y m i n u t e s after the accident a n d w a s g i v e n m e d i c a t i o n to decrease s w e l l i n g o f the b r a i n . S h e w a s transferred to another h o s p i t a l f o r t y - f i v e m i n u t e s later. h a e m a t o m a a n d a basal s k u l l fracture.  K T was comatose for four days.  she b e g a n to m a k e seizure t y p e m o v e m e n t s .  O n the f o u r t h day  H e r first v o c a l i z a t i o n p o s t i n j u r y o c c u r r e d three  m o n t h s later, w h e n she g i g g l e d i n response to a j o k e . m a k i n g guttural sounds, then b a b b l i n g sounds. inventory of four or five words.  A C T scan r e v e a l e d subdural  In the next f e w m o n t h s , she  began  B y e l e v e n m o n t h s p o s t i n j u r y , she h a d an  A t t w e l v e m o n t h s p o s t i n j u r y , she b e g a n r e c e i v i n g  speech  therapy i n a p r e s c h o o l e n v i r o n m e n t . A t t w o years p o s t i n j u r y , K T ' s language w a s s t i l l a m a j o r c o n c e r n .  H e r m o t h e r reported  that K T h a d d i f f i c u l t y e x p r e s s i n g her ideas but that language u n d e r s t a n d i n g w a s adequate f o r simple material. A t the  time  M e m o r y was a major problem. o f testing f o r the present study, ten a n d a h a l f years p o s t i n j u r y , K T  was  i n d e p e n d e n t l y m o b i l e a n d attended a class f o r e d u c a b l e m e n t a l l y h a n d i c a p p e d c h i l d r e n at a local  school.  She  c o n t i n u e d to have  major  c o m p r e h e n s i o n w a s r e p o r t e d l y adequate  memory problems  and anomia.  Language  f o r s i m p l e m a t e r i a l , but syntax w a s d i s o r d e r e d i n  sentence p r o d u c t i o n .  Subject 3 - K F : KF  was  collision.  12 years o f age w h e n the car she w a s r i d i n g i n w a s i n v o l v e d i n a h e a d - o n  K F w a s severely i n j u r e d .  T h e d r i v e r o f the car w a s k i l l e d .  a m b u l a n c e , she w a s i n respiratory arrest. i n c l u d i n g a severe c l o s e d h e a d i n j u r y . haematoma  and cerebral edema.  U p o n a r r i v a l o f the  O n a d m i s s i o n to h o s p i t a l , she h a d m u l t i p l e injuries A C T scan o n e m o n t h p o s t i n j u r y s h o w e d a t e m p o r a l  I n the i n t e n s i v e care u n i t , she r e q u i r e d tracheostomy  p u l m o n a r y toilette a n d h a d a n i n t e r n a l p s e u d o m e m b r a n e o u s spasticity i n her u p p e r a n d l o w e r l i m b s .  colitis.  for  She developed marked  A t s i x w e e k s p o s t i n j u r y , she c o u l d f o l l o w s i m p l e  19  one-step c o m m a n d s . "yes"  B y f o u r m o n t h s p o s t i n j u r y , h e a d c o n t r o l h a d i m p r o v e d a n d she c o u l d say  a n d " n o , " n o d a n d shake her h e a d a p p r o p r i a t e l y , a n d apparently understand s i m p l e  questions.  H e r speech w a s n a s a l a n d d y s a r t h r i a  A t the t i m e o f testing f o r the present study, o n e year p o s t i n j u r y , K F w a s independently m o b i l e i n a w h e e l c h a i r a n d h a d b e g u n to w a l k short distances. i n her u p p e r a n d l o w e r l i m b s . remained dysarthria  M u s c l e tone r e m a i n e d elevated  S h e h a d a palatal l i f t to r e d u c e n a s a l i t y but her  She was self-conscious  about the q u a l i t y o f her speech  speech  and, during  testing, w a s reluctant to be r e c o r d e d o n audiotape. K F l i v e s at h o m e w i t h her father a n d o l d e r sister. classes.  S h e n o w attends r e g u l a r grade nine  A p e r s o n a l aide takes her to s c h o o l a n d assists h e r w i t h w r i t i n g a n d p e r s o n a l care.  She receives  speech, p h y s i o - a n d o c c u p a t i o n a l therapy o n c e a w e e k as an outpatient i n a  nearby h o s p i t a l .  Subject 4 - K V : K V w a s 8 years o l d w h e n she suffered a m o d e r a t e l y severe c l o s e d h e a d i n j u r y w h e n she w a s struck b y a car w h i l e c r o s s i n g the street w i t h h e r m o t h e r . unconscious.  When  she  a r r i v e d at  incomprehensible vocalizations.  hospital  her  eyes  She was rendered immediately  opened  to  pain  and  she  made  S h e h a d i n c r e a s e d tone i n the u p p e r extremities a n d her head  w a s rotated to the left, apparently d u e to s p a s m o d i c t o r t i c o l l i s related to her p r i m a r y b r a i n injury.  A C T scan i n d i c a t e d a s m a l l haemorrhage adjacent to the r i g h t lateral v e n t r i c l e .  r e m a i n e d c o m a t o s e f o r f o u r d a y s . T h e t o r t i c o l l i s r e s o l v e d i n the f o l l o w i n g w e e k s .  KV  She began  t a l k i n g three w e e k s p o s t i n j u r y . KV  l i v e s at h o m e w i t h her mother, father a n d y o u n g e r brother.  C a n a d a i n M a r c h , 1986.  H e r f a m i l y c a m e to  K V ' s first language is S p a n i s h a n d she h a d been s p e a k i n g E n g l i s h  f o r eighteen m o n t h s at the t i m e o f the accident.  20  A n e d u c a t i o n report at one y e a r a n d o n e m o n t h p o s t i n j u r y s h o w s that K T at that t i m e w a s e x p e r i e n c i n g average a c a d e m i c a c h i e v e m e n t w i t h s o m e m i l d a u d i t o r y retention d i f f i c u l t i e s . S h e r e c e i v e d a m o d e r a t e l y l o w score o n a test o f o n e - w o r d v o c a b u l a r y c o m p r e h e n s i o n . Scores on  the W I S C - R w e r e w e l l w i t h i n n o r m a l l i m i t s , w i t h the e x c e p t i o n o f the D i g i t S p a n subtest,  w h i c h i n d i c a t e d a m i l d a u d i t o r y short-term m e m o r y d e f i c i t .  K V is c u r r e n t l y e n r o l l e d i n a  r e g u l a r grade class at a p u b l i c s c h o o l i n her c o m m u n i t y w h e r e she is m a k i n g average a c a d e m i c progress.  Subject 5 - D T : D T w a s 12 years o f age w h e n the m o t o r c y c l e he w a s r i d i n g w a s h i t b r o a d s i d e b y a car. H e was rendered immediately unconscious.  O n a r r i v a l at a nearby h o s p i t a l , he w a s m o v i n g  h i s l i m b s a b n o r m a l l y . H i s left p u p i l b e c a m e d i l a t e d a n d he h a d a g e n e r a l i z e d seizure.  H e was  transferred i m m e d i a t e l y to a larger f a c i l i t y a n d , e n route, h a d another g e n e r a l i z e d seizure.  A  C T s c a n , m a d e i m m e d i a t e l y o n a r r i v a l , r e v e a l e d s w e l l i n g o f the left c e r e b r a l h e m i s p h e r e a n d c o n t u s i o n o f the left f r o n t a l l o b e . internal capsule.  T h e r e w a s a deep h a e m o r r h a g e i n the r e g i o n o f the left  H e h a d n o e y e - o p e n i n g response to p a i n a n d a G l a s g o w c o m a score o f 6/15.  H e h a d r i g h t h e m i p a r e s i s w i t h a l m o s t n o m o v e m e n t i n the r i g h t l o w e r l i m b s . A  s c h o o l r e p o r t w r i t t e n at n i n e m o n t h s p o s t i n j u r y describes D T as a h a p p y c h i l d w i t h  average m a t h e m a t i c a l a n d r e a d i n g a b i l i t i e s , but w h o e x h i b i t e d d e f i c i t s i n several areas o f learning.  D T h a d d i f f i c u l t y f o l l o w i n g o r a l d i r e c t i o n s , h a d severe short-term m e m o r y d e f i c i t s ,  w a s e a s i l y d i s t r a c t e d , a n d h a d a short attention span. but h a d d i f f i c u l t y c o m p o s i n g w r i t t e n m a t e r i a l .  21  H e c o u l d express h i m s e l f w e l l v e r b a l l y ,  Subject 6 - RB: RB  was struck by a motor vehicle as he was crossing the road when he was  12 years of  age. On arrival at hospital, he was comatose and had spastic posturing of all four limbs.  An  X-ray of the skull showed a fracture of the right side. A C T scan revealed a mild depression of the fracture and scattered bilateral contusions of the parietal lobes. At ten days postinjury, RB  opened his eyes spontaneously, but did not respond to commands.  At three weeks  postinjury, he occasionally responded to instructions and could move all four limbs. At four weeks postinjury, RB  was transferred to a rehabilitation hospital. A physical examination  revealed normal cranial nerves, increased extensor tone on lower extremities and flexor tone on upper extremities. RB  smiled at his mother but would not maintain eye contact.  RB's  condition continued to improve over the next few months, but changes in his personality were noted. RB had displayed social and behaviour problems prior to his accident. These problems were accentuated postinjury. RB frequently used abusive language. His behaviour was often erratic, threatening, and lacking in inhibition. An assessment at five months postinjury indicated that RB's language skills were near or above age expectancies. instance, RB  However, exceptions were noted in some language areas.  For  had a poor memory for recent events and a decreased ability to recall known  information on request. He had difficulty understanding idioms, metaphors, meaning carried by intonation, and extracting information from longer paragraph length spoken utterances. His spontaneous language output was excessive and disorganized, with rambling, repetitive themes of conversation. A language assessment at two and a half years postinjury indicated no obvious language deficits in conversation and a normal ability to follow oral commands of increasing length and  complexity.  Word retrieval was  mildly impaired.  inappropriate language in conversation.  22  RB  was  still using  coarse,  Subject 7 - WG: WG  was struck by a car while crossing the street and sustained a severe closed head  injury five days before he turned 9 years of age. He was rendered immediately unconscious and was taken to a nearby hospital where he suffered a right focal seizure which lasted three minutes. His breathing pattern was noted to be abnormal. There was increased muscle tone on both his right and left side and unusually dense left hemiparesis.  He was transferred  immediately by helicopter to a larger facility. A C T scan taken on arrival revealed multiple haemorrhagic contusions throughout the brain, small subdural bleeds bilaterally, compressed ventricles, deformation of the peduncles, and multiple skull fractures. A later C T scan, made eight days postinjury showed that haemorrhagic areas had resolved and that there were lower tenuation areas throughout the brain in the frontal lobes, temporal lobes and particularly in the right parietal lobes. A n E E G made fifteen days postinjury was highly abnormal. His mother described W G  as being a sociable, outgoing and happy child before the  accident. He was reportedly a good student, although no academic records are available. WG  began receiving speech and language therapy one and a half months postinjury at a  rehabilitation centre and continued treatments there for six months. therapy, W G  demonstrated  generalized responses to sensory stimuli.  postinjury localized responses were observed.  At five months, W G  At the initiation of By four months  was able to respond to  simple commands and consistent yes/no responses were established. He could spontaneously use several gestures, sometimes in sequence, to communicate his needs (e.g. "you-me-gokitchen-drink"). Severe attentional deficits were evident. He had very limited control of his oral musculature and could vocalize only /a/ and /vol.  At six months postinjury,  WG  continued to have severe difficulties in speech production, producing only two vowels (/a/ and /if) consistently.  He was oriented to himself and his surroundings, but demonstrated only  23  "concrete processing." He was able to point to one inch by one inch pictures to communicate in structured situation but refused to use this means of communication in naturally occurring situations. During the seventh and eighth month of recovery, when W G received therapy as an outpatient, formal testing was not completed because of W G ' s limited attention span. continued to demonstrate difficulty with orientation to time.  He  He was able to learn new  activities and remember component steps over time. Processing of language was significantly slowed and his attention span for activities was limited to five to ten minutes. At the time of testing for the present investigation, two years and two months postinjury, W G was receiving speech and language therapy as an outpatient from a rehabilitation centre near his home. breathing pattern.  His speech was fluent but marked by hesitations and an uncoordinated Limited attention span continued to be a problem.  24  CHAPTER 3  RESULTS  The mean percent of correct sentences by sentence type for C H I subjects and normal control subjects is shown in Figure 1. type in the Appendix.  Individual subjects scores are summarized by sentence  The means and standard deviations of subjects'  scores for each  sentence type for the control and C H I groups as a whole are presented in Table 3.  An  analysis of variance summary is presented in Table 4 .  Figure 1.  Mean percent of sentences answered correcdy by C H I (open bars) and normal  control (slashed bars) subjects.  (n=7)  100% 90%  MEAN PERCENT CORRECT  80% 70% 60% 50% 40% 30% 20% 10% 0%  \ ! l I!III i ?  _  !  A  P  •  CS  CO  DA  SENTENCE TYPE 25  DP  C  SO  OS  T a b l e 3 . M e a n s a n d standard d e v i a t i o n s b y sentence type f o r c o m b i n e d C H I a n d n o r m a l c o n t r o l g r o u p s (n=14). Sentence T y p e  Mean  s.d.  Active  5.0  0.0  C l e f t subject  4.9  0.3  D a t i v e active  4.7  0.5  Conjoined  4.7  0.5  Passive  4.6  1.1  C l e f t object  4.6  0.8  Dative passive  4.1  1.7  relative  4.0  1.2  Subject-object relative  3.5  1.6  Object-subject  Table 4. groups.  A n a l y s i s of Variance Summary: combined closed head injured and normal control  Source o f Variation b e t w e e n treatments w i t h i n treatments Total  df  SS  8 104 112  36.52 112.86 149.37  MS F = 9.52  4.57 1.09 *  A n a n a l y s i s o f v a r i a n c e w i t h repeated measures o n the sentence type factor r e v e a l e d a s i g n i f i c a n t effect o f this factor o n the n u m b e r o f correct responses  ( F ( 8 , 1 0 4 ) = 9 . 5 2 , p <.01).  T u k e y ' s h o n e s t l y s i g n i f i c a n t d i f f e r e n c e ( H S D ) p r o c e d u r e w a s a p p l i e d at a n e x p e r i m e n t w i s e error rate o f .05 to determine w h i c h means d i f f e r f r o m others. 5.  R e s u l t s are s h o w n i n T a b l e  F o r C H I a n d n o r m a l c o n t r o l scores c o n s i d e r e d as a w h o l e , sentence type S O w a s  26  s i g n i f i c a n t l y m o r e d i f f i c u l t than a l l other sentence types except D P a n d O S .  Sentence type  A w a s s i g n i f i c a n t l y easier t h a n D P , S O a n d O S , a n d sentence type C S r e c e i v e d s i g n i f i c a n t l y h i g h e r scores than d i d S O a n d O S . N o n e o f the m e a n scores o f other sentence types d i f f e r e d s i g n i f i c a n t l y from e a c h other.  N u l l h y p o t h e s i s 1 (p. 15) i s rejected.  A n a l y s e s o f v a r i a n c e w i t h repeated c o n d u c t e d f o r e a c h g r o u p separately. are s h o w n o n T a b l e 6. honestly  measures  o n the sentence type factor w e r e  M e a n scores a n d standard d e v i a t i o n s f o r the C H I group  A n a n a l y s i s o f v a r i a n c e s u m m a r y i s p r o v i d e d i n T a b l e 7.  significant difference  also  procedure  Tukey's  was applied a n d revealed o n l y t w o significant  d i f f e r e n c e s : sentence type S O w a s m o r e d i f f i c u l t than types A a n d C S f o r C H I subjects.  T a b l e 5 . R e s u l t s o f T u k e y ' s P r o c e d u r e ( e x p e r i m e n t - w i s e error rate o f 0.05) a p p l i e d across sentence type f o r c o m b i n e d C H I a n d c o n t r o l g r o u p s (n=14). A  CS  D A  C  P  CO  DP  OS  SO  Note: Sentence types u n d e r l i n e d b y a c o m m o n l i n e are not s i g n i f i c a n t l y different from each other; sentence types n o t u n d e r l i n e d b y a c o m m o n l i n e are s i g n i f i c a n t l y different.  27  T a b l e 6.  M e a n s a n d standard d e v i a t i o n s b y sentence type f o r C H I g r o u p (n=7). Mean  s.d.  Active C l e f t subject Conjoined D a t i v e active C l e f t object  5.0 4.9 4.6 4.4 4.4  Passive Dative passive Object-subject r e l a t i v e Subject-object relative  4.3 3.7 3.7 3.1  0.0 0.4 0.5 0.5 1.1 1.5 2.2 1.4 2.0  Sentence  T a b l e 7.  Type  A n a l y s i s o f V a r i a n c e S u m m a r y : C l o s e d H e a d Injured Subjects  Source of Variation b e t w e e n treatments w i t h i n treatments Total  df  SS  MS  8 48 109.43  20.29 89.14  2.54 1.86  F =  3.1  T h e same p r o c e d u r e s w e r e a p p l i e d to the scores o f the n o r m a l c o n t r o l g r o u p . are s h o w n o n T a b l e 8.  A n a n a l y s i s o f v a r i a n c e s u m m a r y i s presented i n T a b l e 9.  Results F o r this  g r o u p , the m e a n scores associated w i t h S O are s i g n i f i c a n t l y m o r e e l e v a t e d t h a n those o f A , P, and C S .  P a i r e d c o m p a r i s o n s o f a l l other sentence types s h o w e d n o s i g n i f i c a n t  differences.  28  T a b l e 8.  M e a n s a n d standard d e v i a t i o n s b y sentence type f o r n o r m a l c o n t r o l g r o u p (n=7). Mean  Sentence T y p e  Active C l e f t subject D a t i v e active Passive Conjoined C l e f t object Dative passive Object-subject r e l a t i v e Subject-object relative  T a b l e 9.  5.0 5.0 5.0 5.0 4.9 4.9 4.4 4.3 3.9  s.d.  0.0 0.0 0.0 0.0 0.4 0.4 1.1 1.3 1.1  A n a l y s i s o f V a r i a n c e S u m m a r y : N o r m a l C o n t r o l Subjects  Source of Variation b e t w e e n treatments w i t h i n treatments Total  df  SS  8 48 56  9.56 23.72 33.28  MS 1.20 .49  F =  3.2  S u b j e c t s ' scores were a n a l y z e d i n a t w o - f a c t o r a n a l y s i s o f v a r i a n c e w i t h repeated measures o n o n e factor.  T h e between-subjects  T h e repeated measure w a s sentence type. T a b l e 10. p <.05).  factor w a s G r o u p : C H I a n d n o r m a l controls.  A n a n a l y s i s o f v a r i a n c e s u m m a r y is presented i n  A s i g n i f i c a n t m a i n effect w a s f o u n d f o r the G r o u p factor ( F ( l , 1 0 8 ) = 6 . 3 8 , C l o s e d h e a d i n j u r e d subjects r e c e i v e d s i g n i f i c a n t l y l o w e r o v e r a l l scores than d i d  n o r m a l controls.  N u l l h y p o t h e s i s 2 (p. 15) is rejected.  29  T a b l e 10. A n a l y s i s o f V a r i a n c e S u m m a r y : T w o factor (group) repeated measures type) Source of Variation b e t w e e n treatments b e t w e e n subjects (group) repeated measure (sentence type) interaction w i t h i n treatments Total  df  SS  MS  17 1 8 8 108 125  36.52 6.67 27.87 1.98 112.86 149.37  6.670 3.484 .248 1.045  F F F  (sentence  = 6.38 = 3.33 = .24  T h e g r o u p b y sentence type i n t e r a c t i o n w a s not f o u n d to be s i g n i f i c a n t (F(8,108)=0.24, p > 0.1), i n d i c a t i n g that the C H I g r o u p d i d not s i g n i f i c a n t l y d i f f e r f r o m the n o r m a l c o n t r o l g r o u p f o r a n y sentence type. factor ( F ( 8 , 1 0 8 ) = 3 . 3 3 , p <.01).  A s i g n i f i c a n t m a i n effect w a s f o u n d f o r the Sentence T y p e N u l l h y p o t h e s i s 3 (p. 15) is rejected.  Post hoc  c o m p a r i s o n s w e r e not c a r r i e d out as the effect o f sentence type w a s c o n s i d e r e d i n the a n a l y s i s o f v a r i a n c e c o n d u c t e d o n the t w o groups as a w h o l e a n d o n each g r o u p separately. A c o m p a r i s o n o f tables 5 a n d 6 s h o w s that the r a n k i n g o f sentence types b y d i f f i c u l t y is s i m i l a r f o r the C H I a n d n o r m a l c o n t r o l groups.  H o w e v e r , whereas sentence type P was  m o r e d i f f i c u l t than C a n d C O f o r the C H I g r o u p the reverse was true f o r the n o r m a l control group.  A l s o , i n contrast to results f r o m the n o r m a l c o n t r o l g r o u p , the m e a n score  f o r sentence type C w a s h i g h e r than f o r D A i n the C H I g r o u p .  O t h e r w i s e , r a n k scores are  s i m i l a r f o r the t w o g r o u p s a n d resembles the order f o u n d b y C a p l a n et a l . (1985).  30  Sentence-parsing  Strategies  S u b j e c t responses w e r e a n a l y z e d f o r patterns w h i c h c o u l d r e v e a l strategies f o r sentence parsing.  B e c a u s e subjects K T a n d W G gave a m u c h larger n u m b e r o f erroneous  responses  than other subjects, their responses w e r e a n a l y z e d separately. O n s i n g l e v e r b sentences ( A , P , C S , C O ) , K T s h o w e d a strong tendency to interpret the f i r s t n o u n as agent a n d the s e c o n d as theme. v e r b sentences w e r e interpreted this w a y .  S i x t e e n out o f the t w e n t y (16/20) t w o - p l a c e  K T s h o w e d a s i m i l a r tendency w i t h  three-place  v e r b sentences ( D , D P ; 5/10), a l t h o u g h responses to D P sentences w e r e quite v a r i e d .  On  c o m p l e x sentences ( C , S O , O S ) , K T a l m o s t a l w a y s c h o s e the t h i r d n o u n as theme o f the s e c o n d v e r b (14/15). v e r b (10/15).  T h e first n o u n w a s u s u a l l y assigned the r o l e o f the agent o f the  first  H e r c h o i c e as agent o f the s e c o n d v e r b w a s d i v i d e d b e t w e e n the first n o u n  (8/15), the s e c o n d n o u n (6/15) a n d the t h i r d n o u n (1/15). W G ' s responses to v a r i o u s sentence-type were h i g h l y v a r i a b l e .  O n one-place single  v e r b sentences, h i s o n l y error i n v o l v e d a s s i g n i n g the r o l e o f agent to the first n o u n . h a d a h i g h error rate o n three-place v e r b a n d c o m p l e x sentences.  O n three-place v e r b  sentences, he interpreted 5 0 % o f the presentations i n c o r r e c t l y (5/10). w i t h D P sentence c o n s t r u c t i o n s .  M o s t errors o c c u r r e d  T h e r e d i d not appear to be any pattern i n the assignment  o f thematic r o l e o n these sentences. sentences.  WG  W G m i s i n t e r p r e t e d about 4 7 % (7/15) o f the c o m p l e x  F o r these sentences, he u s u a l l y assigned the r o l e o f agent o f the first v e r b to  the first n o u n (11/15). s e c o n d v e r b (10/15). was variable. attention span.  T h e third n o u n w a s u s u a l l y assigned the r o l e o f theme o f the A s s i g n m e n t o f theme o f the first v e r b a n d agent o f the s e c o n d v e r b  It m a y be i m p o r t a n t to note that W G w a s reported to h a v e a r e d u c e d S i n c e c o m p l e x a n d three-place v e r b sentence are l o n g e r than s i m p l e  sentences, he m a y h a v e e x p e r i e n c e d d i f f i c u l t y attending to a l l o f the i n f o r m a t i o n presented i n the l o n g e r sentences a n d u s i n g i n f o r m a t i o n to assign thematic r o l e s .  31  T h e responses o f the f i v e other subjects w e r e c o n s i d e r e d as a w h o l e .  O n single verb  sentences, errors a l m o s t n e v e r o c c u r r e d (1/100) a n d i n v o l v e d assignment o f the agent r o l e to the f i r s t n o u n ( K P - p a s s i v e ) . o c c u r r e d (2/50).  O n the three-place v e r b sentences, errors w e r e almost never  O n e error o c c u r r e d w h e n the t h i r d n o u n w a s a s s i g n e d the r o l e o f theme  a n d the s e c o n d n o u n a s s i g n e d the r o l e o f g o a l ( K F - d a t i v e ) . m i s i n t e r p r e t a t i o n o f the p r e p o s i t i o n " t o " ( R B - d a t i v e ) . c o m p l e x sentences i n 9 % o f the presentations (8/75).  A n o t h e r error i n v o l v e d  T h e f i v e subjects m i s i n t e r p r e t e d the R e s p o n s e s to c o m p l e x sentences  w e r e v a r i a b l e a n d not r e v e a l i n g o f strategies u s e d to assign thematic r o l e .  32  CHAPTER  4  DISCUSSION  T h e p u r p o s e o f this i n v e s t i g a t i o n was to e x a m i n e c o m p r e h e n s i o n o f o r a l language by children w h o have suffered closed head injuries. presented i n the i n t r o d u c t i o n .  T h i s w a s e l u c i d a t e d i n f o u r questions  T h e s e questions are presented a g a i n i n T a b l e 11 f o r ease o f  reference. R e s u l t s o f the present study p r o v i d e i n f o r m a t i o n w h i c h m a y be u s e d to address these f o u r questions: 1.  A s s i g n m e n t o f thematic r o l e f o l l o w s a h i e r a r c h i c a l o r d e r o f d i f f i c u l t y based o n sentence type.  2.  T h i s o r d e r o f d i f f i c u l t y is s i m i l a r f o r the n o r m a l a n d C H I c h i l d p o p u l a t i o n s .  C H I c h i l d r e n h a v e m o r e d i f f i c u l t y a s s i g n i n g thematic roles to n o u n s i n o r a l l y presented sentences than d o n o r m a l c h i l d r e n .  3.  N o p a r t i c u l a r sentence t y p e w a s r e l a t i v e l y m o r e susceptible to interpretation b r e a k d o w n than w a s a n y other sentence type after c l o s e d h e a d i n j u r y .  T h e difference  between  p e r f o r m a n c e o f C H I c h i l d r e n a n d n o r m a l c h i l d r e n o n sentence interpretation tasks w a s o f about the s a m e m a g n i t u d e across sentence types. 4.  T h e h i e r a r c h i c a l o r d e r o f d i f f i c u l t y b y sentence type i n the y o u n g C H I p o p u l a t i o n resembles the order f o u n d a m o n g C H I adults ( B u t l e r et a l . , u n p u b l i s h e d m a n u s c r i p t ) a n d aphasic adults ( C a p l a n et a l . , 1985).  33  T a b l e 11. Q u e s t i o n s addressed i n the present i n v e s t i g a t i o n  1. 2. 3. 4.  Is the assignment o f thematic r o l e m o r e d i f f i c u l t i n s o m e sentence structures than i n others f o r c l o s e d h e a d i n j u r e d a n d n o r m a l c h i l d r e n ? D o C H I c h i l d r e n h a v e m o r e d i f f i c u l t y a s s i g n i n g thematic r o l e than d o n o r m a l c h i l d r e n ? A r e any p a r t i c u l a r sentence types r e l a t i v e l y m o r e susceptible to interpretation b r e a k d o w n than other sentence types i n the y o u n g C H I p o p u l a t i o n ? D o e s the p a r t e m o f sentence interpretation b r e a k d o w n i n C H I c h i l d r e n r e s e m b l e that f o u n d i n C H I adults a n d aphasic adults?  T h e results o f this study suggest that syntactic structure i s a f a c t o r a f f e c t i n g the a c c u r a c y o f thematic r o l e assignment b y the y o u n g C H I p o p u l a t i o n . T h e s i m i l a r i t y b e t w e e n r a n k o r d e r o f sentence types f o r n o r m a l a n d C H I c h i l d r e n suggests that the syntactic features w h i c h affect interpretation o f thematic r o l e are the same f o r b o t h populations. C a p l a n , B u t l e r a n d D e h a u t (1985) i d e n t i f i e d three "elementary structural features" w h i c h c o n t r i b u t e d to the r e l a t i v e d i f f i c u l t y o f thematic r o l e assignment b y adult aphasic s: n o n c a n o n i c a l w o r d order, presence o f a t h i r d thematic r o l e , a n d presence o f a s e c o n d v e r b . R e s u l t s o f the present study i n d i c a t e that these structural features are p a r t i a l determinants o f sentence interpretation d i f f i c u l t y i n the y o u n g C H I p o p u l a t i o n . B e c a u s e o f the s m a l l n u m b e r o f subjects, s o m e o f these effects appear as tendencies.  T h e r o l e o f the f i r s t  feature, w o r d order, c a n be seen i n A , P , D A , a n d D P sentence-types.  T h e active f o r m o f  a sentence tended to be easier than the p a s s i v e f o r m w h e n there w a s an e q u i v a l e n t n u m b e r o f arguments a r o u n d a v e r b ( A versus P ; D A versus D P ) .  S i m i l a r l y , sentences w i t h  e q u i v a l e n t a r g u m e n t structures a r o u n d v e r b s w e r e m o r e d i f f i c u l t w h e n they c o n t a i n e d t w o p r e v e r b a l n o u n phrases than w h e n they w e r e i n c a n o n i c a l f o r m ( C O v e r s u s C S ; S O versus C and O S ) .  34  T h e s e c o n d feature i d e n t i f i e d b y C a p l a n et a l . w a s the presence o f a t h i r d thematic r o l e . T h e e f f e c t o f this feature w a s not d i r e c t l y assessed independent o f sentence l e n g t h .  Single-  v e r b test sentences p o s s e s s i n g a t h i r d thematic r o l e ( D , D P ) c o n t a i n e d m o r e w o r d s than s i n g l e - v e r b t w o thematic r o l e sentences ( A , P ) .  T h e sentence l e n g t h factor w o u l d have  been c o n t r o l l e d w i t h the i n c l u s i o n o f active a n d p a s s i v e c o n j o i n e d theme sentences as d e m o n s t r a t e d i n the f o l l o w i n g :  1) T h e m o n k e y h i t the elephant a n d the rabbit (active c o n j o i n e d theme) 2) T h e turtle w a s h i t b y the goat a n d the elephant (passive c o n j o i n e d theme).  H o w e v e r , e v e n w h e n sentences w i t h a t h i r d thematic r o l e w e r e c o m p a r e d w i t h e m b e d d e d sentences o f e q u a l l e n g t h w h i c h c o n t a i n e d o n l y t w o thematic r o l e s ( D v e r s u s C S ) , they w e r e f o u n d to be m o r e d i f f i c u l t to interpret. T h e t h i r d structural feature i d e n t i f i e d b y C a p l a n et a l . (1985) w a s presence o f a second verb.  T h i s feature w a s f o u n d to affect sentence interpretation i n the y o u n g C H I p o p u l a t i o n .  Sentences w i t h t w o v e r b s tended to be m o r e d i f f i c u l t than one v e r b sentences w h e n c a n o n i c a l w o r d o r d e r w a s c o n t r o l l e d ( C a n d O S v e r s u s A a n d CS', S O versus C O ) .  T h u s it  seems that the three structural features i d e n t i f i e d b y C a p l a n as p a r t i a l l y d e t e r m i n i n g a c c u r a c y o f thematic r o l e assignment i n an aphasic adult also affect thematic r o l e assignment i n C H I c h i l d r e n . It i s i m p o r t a n t to r e m e m b e r that structural features are not the o n l y factors d e t e r m i n i n g task p e r f o r m a n c e . W h i l e the t o y a n i m a l m a n i p u l a t i o n task w a s d e s i g n e d to m i n i m i z e effects o f m e m o r y , the r o l e s o f attention a n d m e m o r y m a y not be c o m p l e t e l y r u l e d out as factors c o n t r i b u t i n g to p e r f o r m a n c e .  T w o C H I subjects i n p a r t i c u l a r demonstrated attention  35  p r o b l e m s d u r i n g the test session a n d , a c c o r d i n g to independent c l i n i c a l reports, suffered a degree o f s h o r t - t e r m m e m o r y d e f i c i t . It s h o u l d be n o t e d that subject age w a s l i k e l y a p a r t i a l determinant o f p e r f o r m a n c e o n this task.  N o r m a l subjects, w h o r a n g e d i n age f r o m 9 to 15 years, demonstrated a p o o r e r  p e r f o r m a n c e o n the t o y a n i m a l m a n i p u l a t i o n task than d i d n o r m a l adults i n other studies ( C a p l a n , et a l . , 1985; B u t l e r , et a l . , u n p u b l i s h e d m a n u s c r i p t ) . I n v e s t i g a t i o n o f i n d i v i d u a l responses i n d i c a t e that the y o u n g C H I p o p u l a t i o n uses a strategy b a s e d o n l i n e a r o r d e r o f n o u n presentation to a s s i g n thematic r o l e s i n at least some o f the sentences presented.  K T h a d a strong tendency to a s s i g n r o l e s a c c o r d i n g to the  c a n o n i c a l o r d e r o f thematic roles i n E n g l i s h s i m p l e o n e - v e r b sentences.  S h e a s s i g n e d the  r o l e s o f agent, theme a n d g o a l to the first, s e c o n d , a n d t h i r d n o u n s r e s p e c t i v e l y , thus r e l y i n g o n l i n e a r o r d e r o f o r a l presentation f o r thematic r o l e assignment. seen to a lesser degree a m o n g other C H I subjects.  T h i s tendency i s  H o w e v e r , the l i n e a r o r d e r i n g strategy i s  not a p p l i e d to a l l sentence types, but appears o n l y i n responses o f C H I subjects to s i m p l e sentences w i t h o n e - a n d t w o - p l a c e v e r b s . responses to c o m p l e x sentences.  It does not appear i n the same  subjects'  Strategies u s e d to a s s i g n thematic r o l e s i n c o m p l e x  sentences are not o b v i o u s i n results from the present study.  T h e use o f a strategy based  o n l i n e a r o r d e r o f presentation m a y not be r u l e d out. F u r t h e r i n v e s t i g a t i o n w i t h a greater v a r i e t y a n d m o r e presentations o f c o m p l e x sentence types m a y r e v e a l m o r e about assignment strategies not o b v i o u s from the present results.  L o w scores o b t a i n e d b y W G o n  l o n g e r sentences ( D P , C , S O , O S ) suggest that d e f i c i t s o f attention affect c o m p r e h e n s i o n o f o r a l sentences.  W h e n the a m o u n t o f i n f o r m a t i o n d i d not e x c e e d attention l i m i t a t i o n s ,  assignment o f thematic r o l e , i n W G ' s case, appeared to be r a n d o m . R e s e a r c h i n v e s t i g a t i n g n o r m a l c h i l d l a n g u a g e d e v e l o p m e n t has i n d i c a t e d that, w h i l e k n o w l e d g e o f basic s y n t a x , that i s , c o n s t r u c t i o n s w i t h c a n o n i c a l w o r d o r d e r , i s a c q u i r e d b y  36  age 5 , s p e c i a l i z e d syntactic rules f o r c o m p l e x constructions are g r a d u a l l y mastered age 5 to 10 ( K a r m i l o f f - S m i t h , 1986).  from  U n t i l c h i l d r e n h a v e a c q u i r e d these s p e c i a l i z e d rules,  it has been p r o p o s e d that they a p p l y interpretive strategies w h i c h h o l d f o r s i m p l e c o n s t r u c t i o n s to m o r e c o m p l e x sentence c o n s t r u c t i o n s w h i c h they cannot y e t process f u l l y . O n e o f these strategies, the M i n i m a l D i s t a n c e P r i n c i p l e ( M D P ) ( C h o m s k y , 1 9 6 9 , p . 11), states that "the i m p l i c i t subject o f a c o m p l e m e n t v e r b i s the n o u n phrase m o s t c l o s e l y preceding i t . " T h e M D P holds f o r almost a l l verbs i n E n g l i s h . v e r b s s u c h as  H o w e v e r , sentences w i t h  promise a n d tell d o n o t h o l d to the M D P . C a r o l C h o m s k y (1969) f o u n d that  c h i l d r e n start o u t a p p l y i n g the M D P to a l l sentence types.  A n o t h e r p r o p o s e d strategy , o r  " p r i m i t i v e r u l e " ( C r o m e r , 1 9 7 0 , p . 4 0 5 ) u s e d b y y o u n g n o r m a l c h i l d r e n equates subject w i t h deep o r l o g i c a l subject. in which  surface  U s e o f this r u l e leads to an erroneous interpretation  John i s the l o g i c a l subject o f the i n f i n i t e i n sentences l i k e John is easy to see.  Investigations o f c h i l d r e n ' s interpretation o f sentences c o n t a i n i n g r e l a t i v e clauses have l e d t o several hypotheses.  T h e " p a r a l l e l f u n c t i o n h y p o t h e s i s " ( S h e l d o n , 1974), proposes  that sentences i n w h i c h the head N P o f the r e l a t i v e clause p l a y s the same g r a m m a t i c a l r o l e i n b o t h the m a t r i x a n d the r e l a t i v e clause are easier f o r c h i l d r e n to interpret than sentences i n w h i c h the N P shifts f u n c t i o n . T h i s h y p o t h e s i s accounts f o r the earlier c o m p r e h e n s i o n o f sentences l i k e e x a m p l e 1 than sentences l i k e e x a m p l e 2 :  1)  T h e goat that k i c k s the r a b b i t k i s s e d the m o n k e y .  2)  T h e m o n k e y k i s s e s the goat that k i c k s the rabbit.  H o w e v e r , T a v a k o l i a n (1977) c o n c l u d e d that a " c o n j o i n e d clause a n a l y s i s " better accounted f o r the pattern o f  interpretation that c h i l d r e n m a k e o f sentences c o n t a i n i n g r e l a t i v e clauses.  T h i s h y p o t h e s i s states that c h i l d r e n interpret these sentences as i f they c o n t a i n e d t w o  37  c o n j o i n e d clauses.  A t h i r d h y p o t h e s i s , termed a " p r o c e s s i n g h e u r i s t i c " b y its originators  (de V i l l i e r s , T a g e r F l u s b e r g , H a k u t a a n d C o h e n , 1976)  states that c h i l d r e n use a l i n e a r  o r d e r strategy that interprets N - V - N strings as agent-action-object. R e s u l t s o f the present a n d p r e v i o u s investigations ( C a p l a n et a l . , 1985, B u t l e r et al) h a v e suggested that C H I c h i l d r e n a n d adults a n d aphasics use a strategy to assign thematic r o l e based o n l i n e a r o r d e r o f n o u n a n d v e r b presentation f o r at least s o m e sentence structures.  T h i s strategy appears s i m i l a r to the p r o c e s s i n g heuristic p r o p o s e d b y de V i l l i e r s  et a l . ( 1 9 7 6 ) . T h e strategies that d e v e l o p m e n t a l literature suggest are u s e d b y n o r m a l d e v e l o p i n g c h i l d r e n to interpret sentences m a y be s i m i l a r to those u s e d b y C H I c h i l d r e n a n d adults, a n d b y adult aphasics. M o r e research is needed i n this area before c o n c l u s i o n s c a n be m a d e . W h i l e n o r m a l adults rarely m a k e errors o f sentence interpretation o n the task a d m i n i s t e r e d i n this study ( C a p l a n et a l . , 1985, B u t l e r et a l , u n p u b l i s h e d m a n u s c r i p t ) inaccurate responses o f n o r m a l c o n t r o l subjects i n this i n v e s t i g a t i o n w e r e f a i r l y frequent. F u r t h e r m o r e , as w i t h the h e a d i n j u r e d subjects, a c c u r a c y o f interpretation a m o n g the n o r m a l c h i l d r e n v a r i e d w i t h sentence type.  Responses of normal children f o r m e d a hierarchy of  sentence types b a s e d o n d i f f i c u l t y o f interpretation w h i c h w a s s i m i l a r to that f o u n d o n e x a m i n a t i o n o f C H I a n d aphasic subject responses. T h e f i n d i n g s o f the present study are i n apparent c o n t r a d i c t i o n to those studies w h i c h h a v e s h o w n either n o c o m p r e h e n s i o n d e f i c i t s ( G u t t m a n , 1942;  B r a n c o - L e f e v r e , 1950), o r  r a p i d a n d c o m p l e t e r e c o v e r y o f c o m p r e h e n s i o n ( A l a j o u n i n e a n d L h e r m i t t e , 1965; 1976; 1983)  Hecaen,  i n C H I c h i l d r e n ; the f i n d i n g s are, h o w e v e r , i n agreement w i t h those studies  f i n d i n g r e s i d u a l defects o f c o m p r e h e n s i o n ( L e v i n a n d E i s e n b e r g , 1979;  M i t c h e l l , 1985).  H o w e v e r , w h i l e M i t c h e l l c o u l d not demonstrate that c o m p r e h e n s i o n d e f i c i t s w e r e s y n t a c t i c a l l y based, the present f i n d i n g s suggest that syntactic structure at least p a r t i a l l y  38  determines a b i l i t y to c o m p r e h e n d sentences. to test m e t h o d o l o g y .  T h e d i f f e r e n c e b e t w e e n f i n d i n g s m a y be due  F e w studies h a v e e x a m i n e d c o m p r e h e n s i o n u s i n g m e t h o d s that  c o n t r o l l e d m e m o r y , b e h a v i o u r a l , semantic o r p r a g m a t i c  factors.  L o n g t e r m r e c o v e r y o f language a n d c o g n i t i v e f u n c t i o n s b y c h i l d r e n w i t h h e a d injuries h a v e been s h o w n to be substantial but i n c o m p l e t e .  M i l d linguistic and cognitive  i m p a i r m e n t s m a y not be evident f r o m results o f assessment w i t h c o n v e n t i o n a l test batteries. S a r n o ' s c o n c l u s i o n that "the use o f sophisticated, n e u r o l i n g u i s t i c measures w i t h this p o p u l a t i o n is needed to detect subtle d e f i c i t w h i c h c a n p e r m i t e n l i g h t e n e d c l i n i c a l j u d g e m e n t " ( S a r n o , 1980, p . 691)  s e e m p a r t i c u l a r l y v a l i d i n l i g h t o f the present f i n d i n g s .  39  BIBLIOGRAPHY  A l a j o u a n i n e , T . H . & L h e r m i t t e , F . 1965. 662.  A c q u i r e d A p h a s i a i n c h i l d r e n . B r a i n , 88,  653-  A n n e g e r s , J . F . , & K u r l a n d , L . T . 1979. T h e e p i d e m i o l o g y o f central n e r v o u s s y s t e m t r a u m a . In G . L . O d o m (ed.) C e n t r a l N e r v o u s S y s t e m T r a u m a R e s e a r c h Status R e p o r t . R e p o r t p r e p a r e d f o r N T N C D S , N a t i o n a l Institutes o f H e a l t h , P u b l i c H e a l t h S e r v i c e . A n n e g e r s , I . F . , G r a b o w , J . D . , K u r l a n d , L . T . , & L a w s , E . R . 1980. The incidence, causes a n d secular trends o f head t r a u m a i n O l m s t e d C o u n t y , M i n n e s o t a . N e u r o l o g y , 30, 912-919. A r s e n i , C , C o n s t a n t i n o v i c i , A . , & I l i e s c a , D . 1970. C o n s i d e r a t i o n s o f post traumatic aphasia i n p e a c e t i m e . P s y c h i a t r i c a , N e u r o l o g i c a , N e u r o c h i r u r g i c a , 73, 1 0 5 - 1 1 2 . B a s s e r , L . S . 1962. H e m i p l e g i a o f early onset a n d the f a c u l t y o f speech w i t h s p e c i a l r e f e r e n c e to the effects o f h e m i s p h e r e c t o m y . B r a i n , 85, 4 2 7 - 4 6 0 . B o w e r m a n , M . 1979. T h e a c q u i s i t i o n o f c o m p l e x sentences. I n F l e t c h e r , P . a n d G a r m a n , M . (eds.) L a n g u a g e A c q u i s i t i o n . N e w Y o r k : C a m b r i d g e U n i v e r s i t y Press. B r a n c o - L e f e v r e , A . F . 1950. C o n t r i b u i c a o p a r a o estudo d a p s i c o p a t o l o g i a d a afasia, e m criancas. A r c h i v o s N e u r o - P s i q u i a t r i a , 8, 3 4 5 - 3 9 3 . B u t l e r - H i n z , S . , C a p l a n , D . , & W a t e r s , G . , Characteristics o f syntactic d e f i c i t s f o l l o w i n g c l o s e d head i n j u r y . U n p u b l i s h e d m a n u s c r i p t .  comprehension  C a p l a n , D . 1987. N e u r o l i n g u i s t i c s a n d l i n g u i s t i c a p h a s i o l o g y : A n i n t r o d u c t i o n . C a m b r i d g e , U K : C a m b r i d g e U n i v e r s i t y Press. C a p l a n , D . , B a k e r , C . & D e h a u t , F . 1985. Syntactic determinants o f sentence c o m p r e h e n s i o n i n aphasia. C o g n i t i o n , 21, 117-175. C a p l a n , D . & Futter, C . 1986. A s s i g n m e n t o f thematic r o l e s to nouns i n sentence c o m p r e h e n s i o n b y a n a g r a m m a t i c patient. B r a i n and L a n g u a g e , 27, 17-134. 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T h e A c q u i s i t i o n o f S y n t a x i n C h i l d r e n f r o m 5 to 10. C a m b r i d g e , M a s s . : M I T Press. C r o m e r , R . F . 1970. C h i l d r e n are n i c e to u n d e r s t a n d : surface structure c l u e s f o r the r e c o v e r y o f a deep structure. B r i t i s h J o u r n a l o f P s y c h o l o g y , 61, 3 9 7 - 4 0 8 . D e n n i s , M . & W h i t a k e r , H . A . 1976. L a n g u a g e a c q u i s i t i o n f o l l o w i n g h e m i d e c o r t i c a t i o n : L i n g u i s t i c s u p e r i o r i t y o f the left o v e r the right h e m i s p h e r e . B r a i n a n d L a n g u a g e , 3, 4 0 4 433. D e n n i s , M . & W h i t a k e r , H . A . 1977. H e m i s p h e r i c e q u i p o t e n t i a l i t y a n d l a n g u a g e a c q u i s i t i o n . I n S . J . S e g a l o w i t z & F . A . G r u b e r (eds.). L a n g u a g e D e v e l o p m e n t a n d N e u r o l o g i c a l T h e o r y . N e w Y o r k : A c a d e m i c Press. 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H e c a e n , H . 1 9 8 3 . A c q u i r e d aphasia i n c h i l d r e n : r e v i s i t e d . N e u r o p s y c h o l o g i a , 21,  lournal  581-587.  H e c a e n , H . 1976. A c q u i r e d aphasia i n c h i l d r e n a n d the ontogenesis o f h e m i s p h e r i c f u n c t i o n a l s p e c i a l i z a t i o n . B r a i n a n d L a n g u a g e , 3, 114-134. H e i l m a n , K . M . , S a f r a n , A . , & G e s c h w i n d , N . 1971. C l o s e d h e a d t r a u m a a n d aphasia. J o u r n a l o f N e u r o l o g y , N e u r o s u r g e r y a n d P s y c h i a t r y , 34, 2 6 5 - 2 6 9 . H o o p e r , R . 1969. Patterns o f acute h e a d i n j u r y . B a l t i m o r e : W i l l i a m s & W i l k i n s . L e n n e b e r g , E . 1967.  B i o l o g i c a l Foundations of Language.  N e w York: Wiley.  L e s s e r , R . 1976. V e r b a l a n d n o n v e r b a l m e m o r y c o m p o n e n t s o f the T o k e n Test. N e u r o p s y c h o l o g i a , 14, 7 9 - 8 5 .  41  L e v i n , H . S. 1 9 8 1 . A p h a s i a i n c l o s e d head i n j u r y . N e w Y o r k : A c a d e m i c Press.  I n M . T . Sarno (ed.) A c q u i r e d A p h a s i a .  L e v i n , H . S., & E i s e n b e r g , H . M . 1979. N e u r o p s y c h o l o g i c a l i m p a i r m e n t after c l o s e d head i n j u r y i n c h i l d r e n a n d adolescents. J o u r n a l o f P e d i a t r i c P s y c h o l o g y , 4, 3 8 9 - 4 0 2 . L e v i n , H . S . & G r o s s m a n , R . G . 1978. B e h a v i o r a l sequelae o f c l o s e d h e a d i n j u r y : A quantitative study. A r c h i v e s o f N e u r o l o g y , 35, 7 2 0 - 7 2 7 . L e v i n , H . S . , G r o s s m a n , R . G . & K e l l y , P . J . 1976. A p h a s i c d i s o r d e r i n patients w i t h c l o s e d h e a d i n j u r y , J o u r n a l o f N e u r o l o g y , N e u r o s u r g e r y , a n d P s y c h i a t r y , 39, 1062-1070. L e v i n , H . S., G r o s s m a n , R . G . Sarwar, M . , & M e y e r s , C . A . 1981. Linguistic recovery after c l o s e d head i n j u r y . B r a i n a n d L a n g u a g e , 12, 3 6 0 - 3 7 4 . L e w i n , W . 1966. T h e m a n a g e m e n t o f head injuries. B a l t i m o r e : W i l l i a m s & W i l k i n s . M a r t i n , R . C . & B l o s s o m - S t a c h , C . 1986. E v i d e n c e o f syntactic i m p a i r m e n t i n a fluent aphasic. B r a i n a n d L a n g u a g e , 28, 196-234. R o s e n b a u m , P . 1967. T h e G r a m m a r o f E n g l i s h Predicate C o n s t r u c t i o n s . C a m b r i d g e , M a s s . : M I T Press. R u s s e l l , R . W . 1932. C e r e b r a l i n v o l v e m e n t i n head i n j u r y . B r a i n , 55,  549-603.  S a r n o , M . T . 1980. T h e nature o f v e r b a l i m p a i r m e n t after c l o s e d h e a d i n j u r y . N e r v o u s a n d M e n t a l D i s e a s e , 168, 685-692.  Journal o f  S a r n o , M . T . , B u o n a g u r o , A . , & L e v i t a , E . 1986. Characteristics o f v e r b a l i m p a i r m e n t i n c l o s e d h e a d i n j u r e d patients. A r c h i v e s o f P h y s i c a l M e d i c i n e a n d R e h a b i l i t a t i o n , 67, 4 0 0 405. S h e l d o n , A . 1974. T h e r o l e o f p a r a l l e l f u n c t i o n i n the a c q u i s i t i o n o f r e l a t i v e clauses i n E n g l i s h . l o u r n a l o f V e r b a l L e a r n i n g a n d V e r b a l B e h a v i o r 13, 2 7 2 - 2 8 1 . T a v a k o l i a n , S . L . 1977. Structure a n d f u n c t i o n i n c h i l d language. U n i v e r s i t y o f Massachusetts.  D o c t o r a l dissertation,  T h o m s e n , I. V . 1 9 7 5 . E v a l u a t i o n a n d o u t c o m e o f aphasia i n patients w i t h severe c l o s e d head t r a u m a . J o u r n a l o f N e u r o l o g y , N e u r o s u r g e r y , a n d P s y c h i a t r y , 38, 7 1 3 - 7 1 8 . T h o m s e n , I. V . 1976. E v a l u a t i o n a n d o u t c o m e o f traumatic aphasia i n patients w i t h severe v e r i f i e d f o c a l l e s i o n s . F o l i a P h o n i a t r i c a , 28, 3 6 2 - 3 7 7 . T h o m s e n , I. V . 1977. V e r b a l l e a r n i n g i n aphasic a n d n o n - a p h a s i c patients w i t h severe h e a d i n j u r y , S c a n d i n a v i a n J o u r n a l o f R e h a b i l i t a t i o n M e d i c i n e , 9, 7 3 - 7 7 . W o o d s , B . T . & C a r e y , S. 1979. L a n g u a g e d e f i c i t s after apparent c l i n i c a l r e c o v e r y f r o m c h i l d h o o d aphasia. A n n a l s o f N e u r o l o g y , 6, 4 0 5 - 4 0 9 .  42  Woods, B. T. & Teuber, H. L. 1978. Changing patterns of childhood aphasia. Annals of Neurology, 3, 273-280.  43  APPENDIX Individual Subject Responses Table A - l . Responses and scores for KP by sentence type. 1 2 Active (The monkey patted the rabbit) *1,2: 5/5 1 2 Passive (The monkey was touched by the rabbit) 1,2: 1/5 *2,1: 4/5 1 2 Cleft subject (It was the elephant that kissed the turtle) *1,2: 5/5 1 2 Cleft object (It was the elephant that the turtle touched) *2,1: 5/5 1 2 3 Dative (The elephant took the turtle to the rabbit) *1,2,3: 5/5 1 2 3 Dative passive (The monkey was brought to the turtle by the elephant) *3,1,2: 5/5 1 2 3 Conjoined (The monkey patted the rabbit and pushed the turtle) * 1,2; 1,3: 5/5 1 2 3 Subject-object relative (The elephant that the goat hugged hit the turtle) *2,1;1,3: 5/5 1 2 3 Object-subject relative (The elephant scratched the rabbit that caught the turtle) 2,1;2,3: 1/5 *1,2;2,3: 4/5 Note: The numerals above sentences denote the nouns as they occur from left to right within each sentence. The numerals below sentences represent subjects' responses. The first numeral of a series represents an agent role, the second numeral a theme role, and the third numeral a goal, when this role exists, as in sentence types D and DP. Where two verbs occur in a sentence, thematic roles around each verb are separated by a semi-colon. Numeral before the semi-colon describe thematic roles for the first noun as it occurs in a sentence. Numerals after the colon represent the ratio of subject responses of the type described. For example, KP interpreted one offiveobject-subject relative clause sentences as having the second noun theme of the first verb, the first noun agent of the first verb, the second noun agent of the second verb and the third noun theme of the second verb. The correct interpretation of each sentence type is denoted by *. This notation system is borrowed from Caplan and Futter (1986).  44  Table A-2. Responses and scores for KF by sentence type. 1 2 Active (The monkey patted the rabbit) *1,2: 5/5 1 2 Passive (The monkey was touched by the rabbit) *2,1: 5/5 1 2 Cleft subject (It was the elephant that kissed the turtle) *1,2: 5/5 1 2 Cleft object (It was the elephant that the turtle touched) *2,1: 5/5 1 2 3 Dative (The elephant took the turtle to the rabbit) 1,3,2: 1/5 *1,2,3: 4/5 1 2 3 Dative passive (The monkey was brought to the turtle by the elephant) *3,1,2: 5/5 1 2 3 Conjoined (The monkey patted the rabbit and pushed the turtle) *1,2;1,3: 5/5 1 2 3 Subject-object relative (The elephant that the goat hugged hit the turtle) 2,1;2,3: 1/5 1,2;1,3: 1/5 *2,1;1,3: 3/5 1 2 3 Object-subject relative (The elephant scratched the rabbit that caught the turtle) l,2;(l+2),3: 1/5 * 1,2;2,3: 4/5  45  Table A-3. Responses and scores for K V by sentence type. 1 2 Active (The monkey patted the rabbit) *1,2: 5/5 1 2 Passive (The monkey was touched by the rabbit) *2,1: 5/5 1 2 Cleft subject (It was the elephant that kissed the turtle) *1,2: 5/5 1 2 Cleft object (It was the elephant that the turtle touched) *2,1: 5/5 1 2 3 Dative (The elephant took the turtle to the rabbit) * 1,2,3: 5/5 1 2 3 Dative passive (The monkey was brought to the turtle by the elephant) •3,1,2: 5/5 1 2 3 Conjoined (The monkey patted the rabbit and pushed the turtle) * 1,2;1,3: 5/5 1 2 3 Subject-object relative (The elephant that the goat hugged hit the turtle) *2,1;1,3: 5/5 1 2 3 Object-subject relative (The elephant scratched the rabbit that caught the turtle) * 1,2:2.3: 5/5  46  Table A-4. Responses and scores for RB by sentence type. 1 2 Active (The monkey patted the rabbit) *1,2: 5/5 1 2 Passive (The monkey was touched by the rabbit) *2,1: 5/5 1 2 Cleft subject (It was the elephant that kissed the turtle) *1,2: 5/5 1 2 Cleft object (It was the elephant that the turtle touched) *2,1: 5/5 1 2 3 Dative (The elephant took the turtle to the rabbit) *U,3: 4/5 other: 1/5 (interpreted "to" as "from") 1 2 3 Dative passive (The monkey was brought to the turtle by the elephant) *3,1,2: 5/5 1 2 3 Conjoined (The monkey patted the rabbit and pushed the turtle) 3,2;3,1: 1/5 * 1,2; 1,3: 4/5 1 2 3 Subject-object relative (The elephant that the goat hugged hit the turtle) 3,1;1,2: 1/5 *2,1;1,3: 4/5 1 2 Object-subject (The elephant scratched the rabbit that caught the turtle) *1,2;2,3: 5/5  47  3  Table A-5. Responses and scores for DT by sentence type. 1 2 Active (The monkey patted the rabbit) *1,2: 5/5 1 2 Passive (The monkey was touched by the rabbit) *2,1: 5/5 1 2 Cleft subject (It was the elephant that kissed the turtle) *1,2: 5/5 1 2 Cleft object (It was the elephant that the turtle touched) *2,1: 5/5 1 2 3 Dative (The elephant took the turtle to the rabbit) * 1,2,3: 5/5 1 2 3 Dative passive (The monkey was brought to the turtle by the elephant) *3,1,2: 5/5 1 2 3 Conjoined (The monkey patted the rabbit and pushed the turtle) *1,2;1,3: 5/5 1 2 3 Subject-object relative (The elephant that the goat hugged hit the turtle) *2,1;1,3: 5/5 1 2 3 Object-subject relative (The elephant scratched the rabbit that caught the turtle) 1,2;3,2: 1/5 *1,2;2,3: 4/5  48  Table A-6. Responses and scores for KT by sentence type. 1 2 Active (The monkey patted the rabbit) *1,2: 5/5 1 2 Passive (The monkey was touched by the rabbit) 1,2: 4/5 *2,1: 1/5 1 2 Cleft subject (It was the elephant that kissed the turtle) 2,1: 1/5 *1,2: 4/5 1 2 Cleft object (It was the elephant that the turtle touched) 1,2: 3/5 •2,1: 2/5 1 2 3 Dative (The elephant took the turtle to the rabbit) 2,1,3: 1/5 *1,2,3: 4/5 1 2 3 Dative passive (The monkey was brought to the turtle by the elephant) 1,2,3: 1/5 2,1,3: 2/5 2,3,1: 1/5 other: 1/5 (picked up 1 and put 2 behind 3) *3,1,2: 0/5 1 2 3 Conjoined (The monkey patted the rabbit and pushed the turtle) 1,2;2,3: 1/5 *1,2;1,3: 4/5 1 2 3 Subject-object relative (The elephant that the goat hugged hit the turtle) 1,3;2,3: 1/5 2,1;2,3: 2/5 1,2;1,3: 1/5 other: 1/5 (arranged 1, 2 and 3 together) *2,1;1,3: 0/5 1 2 3 Object-subject relative (The elephant scratched the rabbit that caught the turtle) 2,1;3,1: 1/5 1,2;1,3: 3/5 *1,2;2,3: 1/5  49  Table A-7. Responses and scores for WG by sentence type. 1 2 Active (The monkey patted the rabbit) *1,2: 5/5 1 2 Passive (The monkey was touched by the rabbit) *2,1: 5/5 1 2 Cleft subject (It was the elephant that kissed the turtle) * U : 5/5 1 2 Cleft object (It was the elephant that the turtle touched) 1,2: 1/5 *2,1: 4/5 1 2 3 Dative (The elephant took the turtle to the rabbit) 1,3,2: 1/5 * 1,2,3: 4/5 1 2 3 Dative passive (The monkey was brought to the turtle by the elephant) 1,2,3: 1/5 2,1,3: 1/5 2,3,1: 1/5 other: 1/5 (picked up 1 and put 2 behind 3) *3,1,2: 1/5 1 2 3 Conjoined (The monkey patted the rabbit and pushed the turtle) 3,2;1,3: 1/5 *1,2;1,3: 4/5 1 2 3 Subject-object relative (The elephant that the goat hugged hit the turtle) 1,3; 1,2: 1/5 2,1;0,0: 1/5 1,2;1,3: 1/5 1,2;2,1: 1/5 *2,1;1,3: 1/5 1 2 3 Object-subject relative (The elephant scratched the rabbit that caught the turtle) 2,1;3,1: 1/5 0,0;2,3: 1/5 *1,2;2,3: 3/5  50  

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