Journal

The Japanese journal of neuropsychology

[Vol.34 No.1 contents]
Japanese/English

Full Text of this Article
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ArticleTitle Fluency-related problems associated with planning of training for aphasia patients
Language J
AuthorList Yukihiro Izawa1)2), Tomoyuki Kojima3)4)
Affiliation 1)Department of Childhood Education, Faculty of Education, Fukuyama City University
2)Division of Speech Therapy, Department of Rehabilitation, Okayama Rehabilitation Hospital
3)Graduate School of Human and Social Sciences, Musashino University
4)Ichikawa Consultancy for Higher Brain Dysfunction
Publication Japanese Journal of Neuropsychology: 34 (1), 16-28, 2018
Received
Accepted
Abstract The first half of this article outlines the history of discussion about the fluent/non-fluent dichotomy for aphasia, which is an issue that can be traced back to Jackson or Wernicke in the late 19th century. Researchers realized that there were two types of aphasia: one in which speech is mostly or completely lost (speechlessness), and one in which errors occur in the use of words despite an abundant vocabulary (defective speech). During the 1960s and 1970s, the concept of fluency in aphasia was clarified by Boston scholars, and the discussion evolved to include typology that mainly divided aphasia into fluent aphasia and non-fluent aphasia on a scale. At that time, the fluent/non-fluent dichotomy attracted considerable attention because the site of the lesion could be approximately estimated. On the other hand, some researchers opposed the adoption of this dichotomy, such as Poeck. While the importance of fluency in aphasia was being debated, Jakobson (1963) proposed a linguistic solution, suggesting that two basic linguistic operations (referred to as "selection" and "binding") divided the speech pathology of aphasia into two parts. Jakobson proposed that disorders of selection corresponded to aphasia and disorders of binding corresponded to expressive aphasia. This perspective is still important today when conducting qualitative evaluation of aphasia. Based on the discussion in the first half of the article, the second half addresses problems with categorizing aphasia as fluent/non-fluent from the perspective of treating patients. Using four cases as examples, it is suggested that speech training for patients referring to disability structures cannot necessarily be planned appropriately when actual patients are evaluated by using a fluency scale. For Case A, there was a problem with comprehensive assessment due to debate over evaluation because inner speech was fluent, while narrowly defined speech demonstrated non-fluency due to anarthria. With regard to Case B, even though the disability structure remained the same, the profile showed a transition from "non-fluent" to "fluent" over the course of time. Case C was considered to be non-fluent based on factors associated with other inner speech, even though anarthria was not observed. Case D had transcortical sensory aphasia due to an anterior lesion, raising the issue of "fluency evaluation" as a method of estimating the lesion location. In summary, the underlying mechanism that leads to fluency/non-fluency of a patient's speech needs to be clarified to plan speech training correctly, because the training adopted may vary depending on the details of the mechanism. Quantitative evaluation based on a "fluency scale profile" can be useful for general understanding of the clinical picture. However, it is essential to advance further to qualitative evaluation for performance of rehabilitation. The fluent/non-fluent approach to aphasia might well have outlived its usefulness in the current environment, particularly when speech training for patients is planned, although the fluent/non-fluent dichotomy remains historically significant.
Keywords aphasia, fluency of speech, dichotomy, mechanism of language disorders, training plan for aphasia patients

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