16.94, Review: Neurolinguistics: Fabbro (2004)

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Subject: 16.94, Review: Neurolinguistics: Fabbro (2004)

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1)
Date: 12-Jan-2005
From: Ramesh Mishra < rkm_du at yahoo.co.in >
Subject: Neurogenic Language Disorders in Children 

	
-------------------------Message 1 ---------------------------------- 
Date: Fri, 14 Jan 2005 02:28:19
From: Ramesh Mishra < rkm_du at yahoo.co.in >
Subject: Neurogenic Language Disorders in Children 
 

EDITOR: Fabbro, Franco
TITLE: Neurogenic Language Disorders in Children
PUBLISHER: Elsevier Ltd.
YEAR: 2004
Announced at http://linguistlist.org/issues/15/15-2544.html


Ramesh Kumar Mishra, Lecturer in Linguistics. Dept. of Speech Pathology, 
All India Institute of Speech and Hearing. Mysore, Karnataka, India

SUMMARY

This volume of papers on neurogenic language disorders in children, edited 
by Franco Fabbro is the outcome of the International Symposium of the 
IALP's (International Association for Logopedics and Phoniatrics) Aphasia 
Committee on Neurogenic Language Disorders in Children, held in Cividale 
del Friuli (Udine, Italy) in 2003. There are twelve papers in all and they are 
self-contained with reference lists attached at the ends. Most of the papers 
are from authors based in European scientific establishments. The papers 
have not been divided into any groups. At the end of the book there are 
subject and author indices. Various empirical and meta-analytical research 
syntheses on different kinds of childhood neurogenic language disorders 
(acquired childhood aphasia, Landau Kleffner's Syndrome, Crossed aphasia 
etc) following different kinds of methodologies (radiological, behavioral, 
case studies) have been assembled in this volume. In spite of their diversity, 
they all address critical issues concerning diagnosis, prognosis and long 
term outcomes of childhood neurogenic language disorders in children 
because of acquired lesions in the brain. This is perhaps a first edited book 
containing all the papers exclusively on an important theme like childhood 
neurogenic language disorders.  The book is addressed to researchers and 
clinicians working in the field of aphasiology and neurogenic language 
disorders in children and other researchers in neurolinguistics and speech 
language pathology.	

Franco Fabbro's introductory chapter (pp. 1-7) makes a clear categorization 
of different childhood language disorders with neurogenic etiologies and 
their specific differentiating features thus making the thematic background 
for all following chapters. Fabbro's experience as an researcher and author 
in the area of language pathology and neurolinguistics reflect in the clarity 
of the statements he makes when he includes only a particular types of 
childhood language disorders of neurogenic origin in this volume. May be 
they are in the forefront of research (like epileptic aphasias and LKS). The 
author gives the basic neurological symptoms of the common neurogenic 
language disorders in children along with their linguistic correlates based 
on which they are currently diagnosed. Fabbro raises the basic debate of 
recovery of language abilities in children who have localized brain lesions 
compared to adults who have aphasia. This issue is still controversial in 
neurolinguistics. In the lights of new findings he says that "[in] relation to 
acquired childhood aphasia, recovery from adult aphasia remains one of 
the hotly debated issues today". Before the early 1970s language recovery 
in children with aphasia was believed to be rapid and complete (Lenneberg, 
1967). But many of the papers in this volume show that this is not the case 
and children still suffer from several kinds of subtle language impairment 
even after recovery from medical neurological symptoms (p. 2). This theme 
of brain plasticity and language recovery from aphasia in children and 
adults again discussed in many empirical studies in this volume. Fabbro 
describes the genetic disorders like mental retardation, Down's syndrome, 
William's syndrome, Fragile X syndrome, and Turner syndrome. But none of 
the chapters are devoted to these disorders. In conclusion, the author 
makes the very pertinent remark, "each single disorder should also be 
studied keeping in mind the whole range of childhood language disorders" 
(p.6)

Chapter 2 titled, 'Pathophysiological Basis of Aphasia and Verbal Outcome 
in Landau-Kleffner Syndrome' (9-23) is by Marie-Noelle, Metz-Lutz and 
Steve Majerus. It examines the diverse nature of verbal impairment in 
children with LKS using ERP and PET. After providing a brief historical 
background of this syndrome, the authors discuss clinical features of 
acquired epileptic form aphasia, particularly those forms of the disorders 
where they show that the typical EEG recorded during wakefulness showing 
paroxysmal spike-wave discharges (SWDs) found in patients with LKS and 
the typical EEG recorded during continued spike waves discharges during 
slow sleep as a hallmark for the diagnosis of the disease. While discussing 
the typical neuropsychological deficits observed in children with LKS the 
authors analyze deficits in receptive language, auditory comprehension, 
agrammatic language output while comparing finding with other published 
results. A paragraph on clinical evolution of LKS includes the effect of 
neurological abnormalities on the changing aphasic manifestations. The 
authors observe that the actions of the anti-epileptic drugs on speech and 
language behaviour in such patients have not been understood clearly so 
far. Under the heading, ' Late Outcome of LKS', the authors draw n several 
studies to focus on the nature of expressive and receptive languages in 
patients with LKS after they have recovered. While discussing the 
pathophysiological basis of epileptic aphasia, the authors review studies 
that have shown metabolic evidences, neurophysiological findings and EEG 
patterns in age-related focal epilepsy. The last section before the 
discussions is devoted to the interpretation of findings from their earlier 
studies, which show the evidence for persistent dysfunction in the superior 
temporal cortex with impairment of the phonological short-term memory. 
Then there is the evidence of reduced glucose uptake in the brains of the 
patients with LKS in studies using PET. In the overall discussion section the 
authors advance a provisional pathophysiological accounts of aphasic 
disorders an late outcome of LKS and suggest a more or less direct 
relationship between the epileptic activity which they call inhibitory and 
induces phonological short-term memory and other types of verbal 
impairments.

Chapter 3 by Roberto Tuchman is titled 'Acquired Language Disorders and 
Epilepsy: From Landau-Kleffner's Syndrome to Autistic Regression' (25-35). 
The paper starts with a rather comprehensive survey of literature on 
acquirer aphasia with convulsive disorder with particular reference to LKS 
and then discusses the regression in speech and language in children with 
autism who also have epileptic form EEG.  Towards the conclusion the 
authors note that, ' acquired epileptic form aphasia associated with epilepsy 
or epileptic form abnormalities are not specific entities. The studies 
reviewed here suggests that they present part of a spectrum disorder with a 
common pathophysiology with varying severity of clinical manifestations 
dependent on the location and quantity of epileptic form activity (p.32). 
Theses discussions raise the question of the exactness of relating EEG 
results to clinical symptoms of a disorder for diagnosis purpose. Although 
the advancement of such sophisticated techniques as EEG and 
Magnetoencephalography have helped researchers to locate the precise 
locations of neurological/chemical dysfunctions, but in a clinic one sees a 
range of clinical symptoms which are difficult to link. This paper is not an 
empirical investigation but presents a review-based analysis of other 
research findings and offers a synthesis for looking at the disorder from r 
pint of view.

Chapter 4 is titled 'Persistent Subtle Language and Learning Deficits in a 
Child With Acquired Epileptic Form Opercular Syndrome' (37-48) is written 
by Paula Cipriaui, Anna M. Chilosi, Claudia Casaliui, Luria Pfanner and 
Giovanni Cioni. The chapter repots the findings of a three year long case 
study of a child with Acquired Epileptic form Opercular Syndrome (AEOS) or 
also known as Foix-Chavanny Marie Syndrome (FCMS) and focuses on his 
persistent subtle long term language and learning difficulties due to 
impaired phonological processing. In the introduction where the 
symptomatic history of AEOS is given, the authors note that, "AEOS and LKS 
would represent neurological disorders, sharing similar pathophysiological 
mechanisms in which long standing electrical dysfunctions of perisylvian 
neurons translates into bilateral neurological dysfunction" (p.38). The long-
term fluctuations in speech and language abilities in these patients are 
attributed to the changing electro-chemical status of the brain when the 
syndrome is active and when not.  Previous authors in this volume where 
EEG normalcy has been taken to be a condition for impairment in speech 
and language functions in other neurological syndromes have noted similar 
observations. The authors discuss clinical, neuropsychological and EEG data 
from 5.3 years to 6.4 years of the child on several linguistic variables to 
argue for their positions. The brief discussion on the long-term outcomes 
of the child describes his severe reading a writing impairment.

Chapter 5 by Anna Chilosi, Chiara Pecini, Paola Cipriani, Daniela Brixxolava, 
Paola Brovedani, Giovani Ferretti, Lueia Pfanner and Giovanni Ceoni is 
titled, 'Cerebral Language Lateralization and Early Linguistic Development in 
Children with Focal Brain Lesions' (49-63). Here the shift is from epilepsy 
induced neurological conditions like LKS to young children with early 
damage to left and right hemispheres. This paper discusses the longitudinal 
studies conducted on such children with a focus on their focal lesion type 
and early Lateralization of language in such children. The introduction 
reviews such concepts like 'plasticity' and 'equipotentiality' in relation to 
early hemispheric specialization of language (Lenneberg, 1967) and also 
the importance of dichotic listening paradigm to investigate such issues 
(Kimura, 1961, 1967). These are old and still unsolved problems in the 
domain of brain -language discussion. As an empirical paper, the authors 
provide information on subjects, MRI assessment results, 
electrophysiological tests, and linguistic assessments along with the results 
of dichotic listening. The results indicate a very early left hemisphere 
specialization; significant linguistic deficits in children with left side focal 
lesions compared to right side lesions (this has been a repeated 
observation in the literature) and plasticity seen with the potential for 
regeneration as significant language recoveries have been observed in such 
children. The study points out towards the long-term language outcomes in 
such children and their therapeutic management.

Chapter 6 is titled, 'Language Disorders Associated with Paroxysmal 
Abnormalities During NREM Sleep After Very Early Brain Lesions' (65-85) 
and is by Fabbro, Tavano, Cristofori and Borgatti. This has descriptions of 
several case studies. The authors provide very detailed neurological, 
medical and linguistic evaluations along with EEG and MRI results of 
subjects whom they have followed since a long time. These children have 
early lesions in cortical and subcortical areas and show different degrees of 
language impairments. Based on their EEG findings the authors argue that 
the presence of epileptic form abnormalities in NREM sleep is a key 
predictive factor for cognitive/linguistic delay in children with early brain 
lesions. This paper strongly consolidates the evidence that paroxysmal 
abnormalities in the EEG of children with or without epileptic seizures are 
strong clinical criteria. . This paper seems to argue that for any form of 
language impairments there must be a neurological basis.

Chapter 7 titled 'Language and Phonological Awareness Abilities of 
Children Treated for Posterior Fossa Tumor' (87-126) is by Murdoch, 
Docking and Ward. The paper starts with an initial discussion of the role of 
cerebellum in language development in general and language impairment 
in specific. This is a hotly argues issue in neurolinguistics today. The 
subjects of the study are children with posterior fossa which the authors say 
accounts for over half of the brain tumors occurring in children (Cohen et 
al, 1980). The paper investigates general language, high level language and 
pre-literacy skills in children following treatment for posterior fossa tumor, 
in the context of tumor types and their associated treatment effects. 
Authors provide very detailed descriptions of each subject's performance on 
a range of linguistic tasks to show individual differences in language 
abilities. The paper concludes that high-level language impairment is 
observed in children with posterior fossa tumors and they link the defects in 
such cases to abnormalities in the cerebellum. The authors argue for the 
children with posterior fossa tumors as a distinct clinical population with 
specific linguistic cognitive impairments.

Chapter 8 by Borgatti, Tavano, and Fabbro is titled 'Language Development 
in Children with Malformations"(127-148). Here the authors raise the 
question of contributions of cerebellum in language development and 
maintenances and how malfunctions localized to one or both cerebral 
hemispheres may result in permanent receptive and expressive deficits. The 
authors subscribe to the proposal that, although subtle and transient, 
language disorders following acquired focal or large cerebral lesions point 
towards involvement of the cerebellum in human language processing. 
They discuss the nature of language impairment in theses patients with 
different degrees of congenital cerebral malformations with extensive use 
of various standardized test batteries to tap memory, visuo-spatial, 
executive functions and language. The findings show noticeable variability 
in the impairment of language in its specific modules according to the age 
of the patient. However the paper does not claim a direct involvement of 
cerebellum in language acquisition or impairment but speculates on it's 
being fully functionally intact for smooth development of language and 
other cognitive abilities.

Chapter 9 by Marien, Paquier, Engelborghs and De Dayn is titled 'Crossed 
Aphasia in Children' (147-180). The chapter is a meta-analysis of several 
primary published reports on acquired childhood aphasia and crossed 
aphasia and also has a detailed analysis of selected cases of crossed 
aphasia. The treatment is quite historical and includes reviews of many 
nineteen-century studies on handedness, dexterity, hemispheric 
specialization and aphasia in childhood (e.g. Cotrad, 1897; Sach and 
Peterson, 1890 and Freud, 1897). Starting with the earliest articulated 
notions of acquired childhood aphasia, the authors examine the nature of 
crossed aphasia and other cases of childhood lesion language disorders 
through 1900 to 1978 (p.150). There is a discussion of crossed aphasia in 
sinistrals and dextrals.  Crossed aphasia in dextrals has been very less 
studies in the literature. In this connection the authors rightly observe 
that "taken together with the extremely low incidence of CAD in children, 
these considerations corroborate the view that lateralized cerebral 
dominance for language represents an innate neurobiological condition" 
(p.169).

Chapter 10 by Raquier, Maldegam, Dongen and Creton is 
titled, 'Recognizable Spontaneous Characteristics in a Young Adult Twelve 
Years after She Became Aphasic as a Child' (181-197). This case study is a 
long-term follow up of an aphasic child focuses on several linguistic 
variables that continue to manifest over year as typical aphasic deficits. The 
analysis focuses largely on the pragmatic aspects of conversational speech 
in terms of comparisons between acute phase and followed up phases. The 
introduction reviews pertinent literature reveling the long term outcomes of 
linguistic and non linguistic skills in children with aphasia acquired after 
onset of language acquisition and states that aphasia symptoms persist till 
late adulthood in very subtle forms (Paquier and van Dongen, 1996; 
Watamori et al 1990). Very careful use of techniques in analysis of 
spontaneous language samples by the authors makes the picture clear and 
conclusions strong. The authors raise a question as per the utility of a 
variable like MLU (Mean Length of Utterance) in measuring outcomes in 
such cases arguing that, "MLU measurements performed at two different 
points in time in the same patient do not show significant differences 
despite a significant recovery, as the measurements are not indicative of the 
intrinsic characteristics of semantic adequacy or morph syntactic complexity 
and exactness" (p.191). This is a very important argument as far as 
methodology of spontaneous language sample analysis is concerned. At the 
end the authors offer a very useful appendix containing descriptions of 
many technical terms used in spontaneous analysis of speech. Issues 
argued in this paper are very important for clinicians and researchers 
working with aphasic patients and trying quantifying language sample for 
analysis.

Chapter 11 by Helena Lehelkova is tiled, 'Recovery from Aphasia After 
Polytrauma in a Czech Child: What is Lost and What is Left"(199-229). This 
is a case study of a Czech child with acquired aphasia and it describes the 
aphasic symptoms in the child during her re-acquisition of language and 
compares them with aphasic deficits in a group of selected Czech adults 
with aphasia. The paper addresses the very important point of continuation 
of aphasic symptoms over time and as age matures in an individual. The 
author first discusses her own past work on aphasia and agrammatism in 
Czech and then provides a very detailed neurological history of the patient 
before coming to issues like, rehabilitation strategies undertaken to 
improve communication skills. The author gives a comprehensive account 
of the linguistic analysis of the patient's samples of spontaneous speech in 
different time intervals. The samples that are compared are narrations and 
conversations.  Then the paper has the patient's performance on various 
standardized tests of language with analysis of the wrong outputs. The 
analysis of her performance after one year shows difference in deficits. In 
her writing and drawing abilities there is variation and dissociations over 
time. This is evident from the pictures of actual data sheets of the patients. 
When the performance of this child is compared to an adult with aphasia 
differences on several linguistic abilities become very clear. This provides 
strong support to the author's claim about continuity of aphasic symptoms, 
their similarities and dissimilarity over time at different age group.

The last chapter of the volume by Isabel Pavao Martins is titled 'Persistent 
Acquired Childhood Aphasia' (231-251). The focus of the paper is on long-
term outcomes of children who have suffered brain damage early in life. 
Authors discuss many of the aphasic symptoms, which either persist or 
change qualitatively as well as quantitatively over time with analyses of 
actual clinical data. The paper discusses clinical data of several aphasic 
patients having different etiology and looks at those typical aphasic 
symptoms that are still visible through tests even after the patient has 
medically recovered. One most important point made by the authors is 
about the age of onset of aphasia and its relation to future chance of 
recovery and changing plasticity of the brain, which has effect on language 
acquisition.   The lesion related variables (site and nature, late epilepsy) but 
not subject-related variables (age, gender, grade of education) are the main 
facts responsible for the outcome of aphasic symptoms (p.244). A well 
argued discussion section takes up the matter of better recovery of aphasia 
in children than in adults. In the conclusion the authors note, "the 
prognosis o acquired childhood aphasia secondary to static brain lesions is 
generally favorable with a higher rate of recovery than in adults. Yet 
language recovery is less complete than that reported after congenital 
lesions, suggesting a reduced plasticity during the first years of life (p. 247).

CRITICAL EVALUATION

This is an excellent collection of papers on a very important theme of 
language disorder and is going to be a valuable reference tool for students, 
researchers and clinicians. The collections of articles have been done with 
good editorial insight. They address diverse issues in neurogenic language 
disorders in children involving very cutting edge research methods. There 
are no typographical errors on any page and the book is very well 
produced. The articles are fairly technical in nature and the volume is 
addressed to professionals in the field.  When majority of publications on 
aphasia exclusively deal with adult forms of the disorder this volume fills 
the gap taking up in depth studies on several kinds of neurogenic disorders 
that are because of early injury to the brain. Authors have taken sufficient 
care in clear descriptions of their methodologies that will help in replication 
of the findings in other languages.

The volume contains paper addressing several pertinent theoretical and 
methodological problems in the area of childhood neurogenic language 
disorders. But some of the themes are very new and the results have to be 
replicated in other languages to verify. Regarding the dependence of EEG 
measures o identify epileptic aphasia one paper's authors note: "However, 
the seizures and the EEG findings do not always correlate with the clinical 
pictures and as such the EEG and the seizures may be only epiphenomena 
that provided for the identification of a diverse group of language-EEG-
epileptic encephalopathy with diverse etiologies" (p.32). This is a 
methodological question. But the papers are up to date research summaries 
of the field. These papers are certainly helpful to know what are the big 
theoretical questions in neurogenic child language disorder today.

REFERENCES

Cohen, M. E., P. K. Duffuer and C. K. Tebbi (1982). Brain tumors in children: 
diagnosis and management. In Major Topics in Pediatric and Adolescent 
Oncology (C. K. Tebbi, ed.), pp. 240-289. G. K. Hill Medical Publishing, 
Boston.

Cotard, J. (1868). Etude Sur l'Atrophie Cerebrale. Faculté de Médécine, Paris.

Freud, S. (1897). Die Infantile Cerebrallmung. Alfred Holder, Wien.

Kimura, D. (1961). Cerebral dominance and the perception of verbal stimuli, 
Canadian J Psychology, 15, 166-71.

Kimura,D .(1967). Functional asymmetry of the brain in dichotic listening . 
Cortex, 3, 163-78.

Lenneberg, E.H. (1967). Biological Foundations of Language. John Wiley and 
Sons. New York.

Paquier, P. and H. R. Van Dongen (1996). Review of research on the clinical 
presentation of acquired childhood aphasia. Acta Neurol Scand, 93, 428-
436.

Sach, B. and F. Peterson (1890). A study of cerebral palsies of early life, 
based upon analysis of one hundred and forty cases. J. NervMent Dis, 
17,295-332.

Watamori, T. S, S. Ssannma and S.Ueda. (1990). Recovery and plasticity in 
child-onset aphasics: ultimate outcome at adulthood, Aphasiology, 4,9-30 

ABOUT THE REVIEWER

I am a lecturer in linguistics teaching clinical linguistics, psycholinguistics 
and general linguistics to undergraduate and postgraduate students of 
speech and hearing sciences. I have a PhD in linguistics from the University 
of Delhi where I worked on phonological constraints in developmental 
dyslexia. I also have M.Phil and MA degrees in linguistics from the same 
university. My research interests are in linguistic theory and language 
disorder, construction grammar, anaphora and morphology in aphasia.





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