History of Aphasiology

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History of Aphasiology
Ling 411 03

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

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Outline of major historical periods

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

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1. Early Studies

• From ancient Egypt to Broca

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An Egyptian surgeon, ca. 3000 B.C.

• If you examine a man with a broken temple,
  when you speak to him, he does not answer, he has
  lost his use of words.

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Early European thinking

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

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Franz Joseph Gall

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

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Galls Phrenology Theory
Wrong, of course! (Why?) Yet the idea of
localization is a good one
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Reactions to Gall

• Pierre Flourens Attacked Gall
• The brain functions holistically
• Supporters of Gall
• Jean-Baptiste Bouillard (18251881)
• Ernst Aubertin (son-in-law of Bouillard)
• Pierre Gratiolet

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A decades-long debate

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

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Marc Dax

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

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Jean-Baptiste Bouillard (France)

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

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Ernst Auburtin (France)

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

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2. Broca, Wernicke, Lichtheim

• The rise of connectionism
• A sophisticated form of locationalism

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Pierre Paul Broca (French,1824-1880)
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Pierre Paul Broca (18241880)

• Heard important presentation by Auburtin in 1861
• Two days later, he got a patient who
• Couldnt talk
• Had malfunction of right side of body
• Died 5 days later
• Broca performed autopsy
• Found lesion in third frontal convolution
• Second patient, also aphasic, also had lesion in
  inferior frontal gyrus

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Principal cortical gyri (schematic)
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Pierre Paul Broca (contd)

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

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Brocas major contributions

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

Broca did not himself propose this designation
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Karl Wernicke (German, 1848-1905)
The most im-portant figure in 19th century
aphasiology
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Karl Wernicke (1848-1905)

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

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Wernickes posterior language area

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

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Two basic language areas
Primary Somato- sensory Area
Primary Motor Area
Brocas area
Wernickes area
Primary Auditory Area
Primary Visual Area
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Two basic language areas
Primary Somato- sensory Area
Primary Motor Area
Phonological Recognition
Phonological Production
Primary Auditory Area
Primary Visual Area
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Wernicke Connectionism

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

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Arcuate Fasciculus
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Wernicke Connectionismand the arcuate fasciculus

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

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Ludwig Lichtheim (German, 1845-1928)

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

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

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

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Jules Dejerine (French)

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

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Diverse Views after Wernicke Lichtheim

• Pierre Marie (France)
• Jules Dejerine (France)
• J. Hughlings Jackson (England)
• Henry Head (England)
• Kurt Goldstein (Germany)
• Aleksandr Luria (Russia)

Color Code Attacked Wernicke Supported
Wernicke Independent innovator
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4. Goldstein, Luria, Geschwind The return of
connectionism
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Kurt Goldstein (1878-1965)

• German
• Studied with Wernicke
• Influenced by Gestalt psychology (Koffka 1935)
• Adopted a holistic approach
• Became the best-known spokesman for this approach
• Important publication in 1948
• Criticized the Wernicke-Lichtheim view of
  conduction aphasia
• Not the arcuate fasciculus but a central area
• Proposed the term Central Aphasia
• Now we see that there are really two kinds of
  conduction aphasia

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Another basic language area?
Central Sulcus
Central area
Brocas area
Wernickes area
Primary Auditory Area
Primary Visual Area
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Another basic language area?
Central Sulcus
Goldsteins area
Brocas area
Wernickes area
Primary Auditory Area
Primary Visual Area
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Lurias positionaccording to Benson Ardila
Luria took a midway stance between the
localizationist and holistic approaches. He
considered language to be a complex functional
system, requiring many different steps in both
comprehension and production simultaneous
participation of multiple cortical areas would be
required for language processing. Although each
cortical area performs a specific process, it
also participates in different functional
systems. Thus, the first temporal gyrus
participates in phoneme discrimination, and its
damage causes difficulty in all functional
systems requiring phoneme discrimination Ben
son Ardila 199619-20 Question Is this really
a midway stance?
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Good and bad localizationist models

• Bad (e.g., Galls phrenology)
• Each local center does a fairly large job, all by
  itself
• Good (e.g. Wernicke-Lichtheim)
• Each local center does a very small job
• Large jobs get done by the operation of several
  or many such local centers working together,
  partly in serial, partly in parallel
  distributed processing
• A local center can participate in several
  different kinds of larger jobs, depending on what
  other centers are working together with it

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Norman Geschwind (1926-1984)

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

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

• Ardila
• Benson
• Goodglass
• Damasio
• Psychologists
• Other contemporaries

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The Great Divide

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

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Modern attacks onWernicke-Geschwind connectionism

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

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Brocas Area Not for Speech Production?
Surgical excision was done in two stages.
Following completion of the second stage, no
speech-related problems were reported.
Patient D.H.
John Pinel, Biopsychology (1990560), Adapted
from Penfield Roberts, 1959
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Brocas Area Not for Speech Production?
What Pinel neglects to mention, but it is in
Penfield Roberts Patient D.H. was a young boy
who had been having seizures, originating in this
part of his brain.
Patient D.H.
John Pinel, Biopsychology (1990560), Adapted
from Penfield Roberts, 1959
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More on patient D.H.

• Eighteen years old at time of surgery
• Had suffered from seizures causing an inability
  to speak from the age of 3 1/2
• Apparently, the congenital abnormality had
  caused displacement of function

Penfield Roberts Speech and Brain
Mechanisms (1959 163)
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end