Aronson, Arnold

Twenty-seven schizophrenic patients free of any known neurologic deficit were tested with an aphasia test battery. The objective of the research was to derive a profile of schizophrenic language performance to permit its comparison with the profiles characteristic of aphasia, apraxia of speech, generalized intellectual impairment, and confused language. Results indicate that schizophrenic patients exhibit a profile of language performance distinctive from those found in aphasia, apraxia of speech, confusion, or generalized intellectual impairment and demonstrate that the disruption of language in schizophrenia is not aphasic in nature.

Thirty-second speech samples were studied of at least 30 patients in each of 7 discrete neurologic groups, each patient unequivocally diagnosed as being a representative of his diagnostic group. Three judges independently rated each of these samples on each of 38 dimensions of speech and voice using a 7-point scale of severity. Computer analysis based on the means of the three ratings on each patient on each dimension yielded results leading to these conclusions: (1) Speech indeed follows neuroanatomy and neurophysiology. There are multiple types or patterns of dysarthria, each mirroring a different kind of abnormality of motor functioning. (2) These patterns of dysarthria can be differentiated; they sound different. They consist of definitive groupings of certain dimensions of speech and voice, deviant to distinctive degrees. (3) Five types of dysarthria were delineated: flaccid dysarthria (in bulbar palsy), spastic dysarthria (in pseudobulbar palsy), ataxic dysarthria (in cerebellar disorders), hypokinetic dysarthria (in parkinsonism), and hyperkinetic dysarthria (in dystonia and chorea). Also, a mixed dysarthria combining elements of flaccid and spastic dysarthrias was identified in amyotrophic lateral sclerosis. (4) Observed occurrence of a single dimension uniquely in a given neurologic disease and distinctive co-occurrence of several dimensions can aid diagnostically in identification of neurologic disorders.

Three judges rated a number of speech characteristics of 20 patients with Wilson’s disease, an inherited metabolic disease. The perceptual data suggest the presence of a mixed dysarthria with prominent ataxic, spastic, and hypokinetic features which were predictable from neurologic data on the patients. Perceptual data on 10 patients, recorded at two specific points in a treatment program, indicate that speech can be used as an effective monitor of progress in the treatment of this disease.

Correlation matrices were used to demonstrate co-occurrence of deviant speech dimensions observed. Application of this technique led to the emergence of eight distinctive clusters of dysfunction. Each of seven neurologic disorders studied had its own unique group or pattern of clusters. However, any one cluster emerged in and was shared by more than one disorder. Inspection of the dimensions present in a cluster permitted giving the cluster a logically determined name based usually on the defective physiology responsible for the cluster. Knowledge of the neuromuscular characteristics of each disorder led to deductions concerning the neuromuscular substrate for each cluster. Intercluster correlations yielded clues concerning co-occurrence of certain neuromuscular defects. Further inspection led to identification of the probable neuromuscular bases of individual deviant speech dimensions. These conclusions may serve as hypotheses for more accurate physiologic and neurophysiologic measurements to further delineate the problems of dysarthria.

Depression, anxiety, and conversion reaction are common in neurologic patients. These disorders can produce neurologic-like symptoms that either mask or intensify those produced by the neurologic disease. This paper reviews clinical and research findings relating psychopathology to the formation and remediation of speech and language disorders in neurologic patients. The need to consider the psychosocial and psychopathological aspects of neurologic communicative disorders, and the link between emotional and communicative processes, are emphasized. Diagnostic criteria for the identification of psychogenic communicative disorders are outlined.

Tongue force, rate of syllable repetition, and judgments of articulatory defectiveness were measures obtained on 19 dysarthric adults with amyotrophic lateral sclerosis and on 125 normal adults. Anterior and lateral tongue forces were measured by means of a pressure transducer clasped between the teeth; the tongue forces were recorded on a pen-writing ECG apparatus. Audio-recorded syllable repetitions of /p/, /t/, and /k/ also were transcribed on ECG paper and counted. Three listeners rated articulatory precision on a 7-point scale of severity. The normal males had significantly higher tongue forces than normal females; normal subjects had significantly higher tongue forces than dysarthric patients; and anterior tongue forces were significantly greater than lateral in normal and dysarthric patients. There was a high negative correlation between tongue force and severity of articulatory defect. Syllable repetitions were significantly slower in the dysarthric patients than in the normal patients, and a high negative correlation was obtained between syllabic rate and severity of articulatory defect.