Making sense of the maze: Exploring the source of neologistic errors in a case of jargon aphasia Melanie Moses 1,2,3, Lyndsey Nickels 2, Christine Sheard 3 Royal Rehabilitation Centre Sydney 1, Macquarie Centre for Cognitive Science, Macquarie University 2, The University of Sydney 3

Neologisms Typify language in jargon aphasia Disagreement re definition and source Different definitions:  any nonword response (e.g Miller and Ellis, 1987)  unrelated to target Vs phonologically-related (e.g. Buckingham, 1987; Schwartz, et al., 1994)

This presentation…. Neologism = nonword responses that are unrelated to target. e.g. ball  dEb  Non-word responses phonologically related to the target = phonological errors. e.g. ball  bIl 

Case Study: KVH 71-year-old-man Left basal ganglia (CVA) in January 2000 Severe fluent jargon aphasia. Wernickes  Conduction Aphasia Fluent spontaneous speech with ++ perseverative, neologistic & semantic jargon Good comprehension at basic conversational level but difficulties at complex level

Aims Determine KVH’s language processing breakdown Determine the source of KVH’s neologisms

Phonological Output Lexicon Speech Phonological Output Buffer Phonological encoding Phonological Input Lexicon Phonological Input Buffer Acoustic-to-phonological conversion Auditory analysis Speech X Mild impairment X Mild impairment X But many phonologically- related errors  can process some phonological information

Conceptual Semantics Lexical Semantics Visual Object Recognition System Phonological Input Lexicon Phonological Input Buffer Acoustic-to-phonological conversion Auditory analysis Orthographic Input Lexicon Abstract Letter Identification Visual feature analysis Speech Print Pictures, seen objects X X X Moderate central semantic deficit

Phonological Output Lexicon Speech Phonological Output Buffer Phonological encoding Lexical Semantics Orthographic Input Lexicon Abstract Letter Identification Letter-sound rules Visual feature analysis Print Pictures, seen objects X X X X More phonologically-related responses to nonwords & regular words  some intact sublexical processing X Severely impaired access to phonological form via lexical reading route

Research Tasks Picture naming, word reading aloud, word repetition 126 items, presented twice Repetition: –few errors, mainly phonological (real & nonword)  mild phonological encoding difficulties –few neologisms Naming & Reading Aloud: –many errors  50% neologistic –large proportion of phonological errors in reading reflects  impaired phonological encoding –imageability effect in naming (Wald = 4.818; p =.028)  semantic impairment.

Where is KVH’s language breaking down?

Phonological Output Lexicon Speech Phonological Output Buffer Phonological encoding Conceptual Semantics Lexical Semantics Visual Object Recognition System Orthographic Output Lexicon Graphemic Output Buffer Writing Phonological Input Lexicon Phonological Input Buffer Acoustic-to-phonological conversion Sound-Letter Rules Auditory analysis Orthographic Input Lexicon Abstract Letter Identification Letter-sound rules Visual feature analysis Speech Print Pictures, seen objects

Where do KVH’s neologisms come from? Let’s first look at the literature…….

Impaired self-monitoring? Poor self-awareness of speech errors in jargon aphasia (Marshall et al., 1998)  more susceptible to neologisms Poor self-monitoring linked with poor auditory comprehension (Ellis et al., 1983) although this is debatable (Nickels & Howard, 1995)

Can impaired self-monitoring account for KVH’s neologisms? Superior self-monitoring in repetition (least errors, few neologisms):  proportionately more errors rejected (Vs. naming or reading)  more likely to reject error than correct response  largest proportion of “don’t know” responses  presence of phonological model in repetition to compare intended with actual response?

But….. In repetition:  just as likely to reattempt a correct as error response and unable to successfully self-correct errors.  reattempted only 20% of errors, only 1 resulting in correct response In picture naming:  many neologisms  significantly more error than correct responses reattempted  more accurate self-monitoring than repetition?  Relationship between neologisms & self-monitoring not straightforward KVH’s neologisms can’t be explained in terms of poor self-monitoring alone.

Impaired phonological encoding? Neologisms reflect severe distortion of a target at phonological encoding level  response contains no target-related phonemes? (e.g. Kertesz & Benson, 1970) Phonological distortion of an error from an earlier stage of lexical access (e.g. Nickels, 2001) (semantic error  phonological error)

Can impaired phonological encoding account for KVH’s neologisms? Could account for the source of some of KVH’s neologisms BUT... he should have produced large numbers of neologisms in repetition as phonological encoding is common to all 3 tasks absence of syllable length effects in any task  primary source of KVH’s neologisms is NOT phonological encoding impairment

Underlying lexical access impairment? Neologisms fill in a “lexical” gap when word selection fails (Buckingham & Kertesz, 1976; Butterworth, 1979, 1992). Butterworth (1979, 1992) proposed “KC” used back-up “device” which generates neologisms after failure to retrieve lexical target. neologisms generated by random assembly of previously produced phonemes – ie. perseveration Obeyed English phonotactic rules Didn’t obey English phoneme frequency x = no underlying lexical target?

Butterworth (1979, 1992) Neologistic errors reflected failed attempt to retrieve the target word at lexical level  default to a neologism-generating “device.” Phonemic variants of a “device” neologism may be used up to 5 or 6 times  string of phonologically similar neologistic responses. Example: b  kl  nd – b  ndIks –  ndIks – z  ndIks – l  ndIks – z  prIks These phonologically-related neologisms are well documented in jargon aphasia

Can impaired lexical access account for KVH’s neologisms? Neologisms may result from severe impairment in accessing the lexical form of the word. Naming = SS  POL X Reading aloud = OIL  SS  POL X Phonological encoding deficits further impact on performance Can access sublexical phonological information in repetition Unable to derive sublexical phonological information from written input

Therefore... insufficient activation of target lexical representation  phonemes from previous responses assembled to form a neologism. neologism fills the lexical “slot” for the missing target (Butterworth, 1979; 1992)  KVH’s neologisms could reflect an underlying impairment accessing the lexical form of the word via both spoken or written modalities.

Perseverative influence on neologisms Majority of KVH’s neologistic errors in all tasks were perseverative (Repetition: 67%; Reading: 83%; Naming 64%). Suggests production of neologisms strongly linked to a process of perseveration

KVH’s perseverative error patterns KVH mainly produced phoneme perseverations in all tasks But different types in Repetition Vs Picture Naming & Reading Aloud

Repetition  Nail  n1l  Star  st1l Short duration, phonologically related to target

Neologistic perseverative strings Picture naming:  p  s  n  pIs  pI  s  pI  s  n  f  r  n pI  (bowl) (glasses) (carrot) (desk) (cannon) Reading aloud:  sibr   sig   sua  sup   sug  (zebra) (chain) (apple) (carrot) (mountain) Long duration, unrelated to target Consistent with neologistic strings in literature on jargon aphasia

KVH’s perseverative errors KVH’s perseverative errors reflect his different levels of processing breakdown, (phonological encoding in repetition, lexical access in reading aloud and picture naming) Consistent with recent research on perseveration (Cohen & Dehaene, 1998, Martin et al., 1998, Moses et al 2004, Hirsh, 1998)

Conclusions KVH’s neologisms most likely reflect impaired activation of phonological forms via the semantic system  Consistent with some research (e.g. Butterworth, 1979, 1992; Simmons and Buckingham, 1992)  Contradicts others proposing neologisms reflect severe underlying phonological encoding difficulties alone (e.g. Kertesz and Benson, 1970; Lecours and Lhermitte, 1969) KVH’s neologisms typical of jargon aphasia Errors are consistent with Butterworth’s (1979, 1992) neologism generator theory Strong link between KVH’s production of neologisms and phoneme perseveration

Future Directions Investigate alternative accounts for production of neologisms e.g. substitution of phonemes based on phoneme frequency (Butterworth, 1992) More detailed discussion of nature of KVH’s perseverative errors and links with neologisms Replication across series of individuals with jargon aphasia

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