Agramatism (neurological disorder): definition, causes and symptoms
The first three years of human life are key to the development and acquisition of speech and language skills. Skills that, in principle, will accompany the person during the rest of their existence.
But there are cases in which this capacity is truncated due to injuries in certain regions of the brain; thus appearing aphasic disorders that lead to deficits like the Agrammatism, which will be discussed throughout this article .
What is the agramatismo?
Agrammatism is considered an alteration of the language of aphasia . Its most notable feature is that the person has a linguistic deficit which is shown by faults referred to morphological structures. That is, it has a great difficulty in joining words in a sentence forming syntactically appropriate sequences.
This failure usually appears in patients diagnosed with Broca aphasia. The fact that it manifests as a difficulty to create syntactic constructions causes it to be considered as another symptom within this type of aphasia.
In any case, after the development of the cognitive neuropsychology of the mid-twentieth century, it became clear that the agrammatism was something much more complex and that could be observed in patients who do not respond to the other requirements for the classic diagnosis of aphasia. Drill. In addition to that the individual differences between the patients were more than remarkable.
At that same moment, an immense debate opened up about whether agramatism could be considered a validated aphasic category. This controversy is still maintained today, there is disagreement between those who advocate the agramatism as aphasic syndrome and what they oppose its validity as such.
But what are aphasias?
According to the general definition of aphasia, it refers to a language disorder caused by brain injuries in one of the areas of language, and that makes the person unable to communicate through speech, writing and even mimicry.
The causes of aphasia can be:
- Cranioencephalic trauma
- Brain infection
- Degenerative process
On the other hand, if we focus on the definition of Broca's aphasia, it is characterized by the practical impossibility of achieving a fluent verbal production and by the use of short and grammatical phrases produced with enormous effort and prosodically.
There are a series of symptoms that are shown more or less consistently in the understanding and production of agrammatic patients.
1. Symptoms associated with linguistic production
These are the most frequent symptoms associated with speech.
1.1. Problems in grammatical morphemes
This symptom is reflected in the selective omission of both free and linked grammatical morphemes . However, this symptom as such is more typical of English-speaking patients, who add push-ups to words. But in languages such as Spanish or Italian it is not possible, since the push-ups are added to the roots.
For example, in the English language you can omit -ed in the word walk, but a person with a Spanish language can not omit -ie in a meal, since it will no longer be a word but a meaningless sound.
Faced with this fact, the omission of free grammatical morphemes and the substitution or omission of grammatical morphemes linked according to the language was considered as proper to the agramatism.
1.2. Mean sentence emission length
One of the symptoms that is observed in the agramatismo, but that does not always appear, is the length of reduced oral emission. In which patients express themselves through expressions and phrases much shorter than usual.
1.3. Dissociation noun-verb
Another symptom that people with agramatism present is the difficulty in accessing verbal forms. That is, patients omit or nominalize the main verbs of the sentences.
This deficit occurs both in structured tasks and in tasks of spontaneous oral production.
1.4. Difficulties in the construction of sentences
These patients use subject-verb-object structures; presenting an enormous difficulty in sentences of greater syntactic complexity. This symptom is the consequence of a lexical deficit that affects the correct selection of verbs.
1.5. Problems in word ordering
It is considered one of the most characteristic features of Agrammatism. Agrammatics patients have difficulties in correctly ordering verbal expressions according to an understandable order, especially in the production of passive phrases or with structures different from the usual ones.
2. Symptoms associated with linguistic comprehension
Until the seventies, the agrammatism was considered an exclusive deficit of the production of language, regardless of whether the linguistic understanding was altered.
But research around auditory comprehension of agrammatics has revealed that these patients show difficulties in some specific syntactic components , which prevents them from understanding some sentence structures. It is specified that the alteration is selective since the patients present a great deterioration in the understanding of certain sentences, but the rest of the syntax remains intact.
Evaluation and diagnosis
Despite the complexity of this deficit, there are no specific tests to evaluate it; the most used tests being the evaluation of aphasia.
At present, the subtests of the Boston and Barcelona tests concerning verbal expression are used : narration of an event and description of an image. The evaluation includes the transcription of the patient's speech with the consequent evaluation of the lexical poverty, the quality of the syntagmas, the incorrect use of morphemes and lexemes, or the incorporation of functional words.
1. Boston Test of Diagnosis of Aphasia (Goodlas and Kaplan, 1972)
It is the most widely used test given its ease of administration. It contains a specific test for vocabulary assessment, and an abbreviated format for quick screening of the patient.
2. Test Barcelona (Peña-Casanova, 1990)
This test assesses all cognitive mechanisms related to language. It is characterized by being an extensive and complicated test but it consists of an abbreviated format.
Treatment: HELPSS method
The beginnings of this method were based on certain studies of the agrammatics, in which techniques of completeness of histories were used in patients with Broca aphasia and agrammatics.
Likewise, this method integrated different levels of difficulty to story completion activities . In this way, the HELPSS methodology includes a succession of stages arranged hierarchically in two levels of difficulty: A and B; working, also, with eleven types of sentences:
- Transitive imperative
- Intransitive imperative
- Declarative transitive
- Interrogative pronominal
- Declarative transitive
- Declarative intransitive
- Direct and indirect object
- Yes / no questions
- Subordinate sentences
Each type of sentence is worked on with both levels of difficulty, presenting twenty stories with different examples of the types of previous sentences, which are exemplified with images but not with written sentences.
During level A, the professional must tell a story that ends with the image of it. Then the patient is asked a question to obtain an answer from the latter by means of an example. When the person reaches 90% of correct answers in a type of sentence, it is passed to level B of the same.
During Level B, the example sentence is omitted; the patient must elaborate the phrase in a genuine way.