Language and Cognition Colombo 2011 Psycholinguistic Assessments of Language Processing in Aphasia - Writing With acknowledgement to Jane Marshall

Aims Familiarise students with writing routes Introduce patterns of writing impairment Familiarise students with methods for assessing writing Introduce principles of therapy and therapy approaches

3 Spelling routes Phoneme to Grapheme conversion –Non-lexical route –Lexical route –Reliance of PGC so regular>irregular spelling Non-semantic/direct lexical route –Accesses a whole word spelling in the orthographic output lexicon from the POL Semantic lexical route –Entry in the OOL is accessed from semantics

Auditory Analysis AIL VIL Visual Analysis POLOOL Semantics Picture Analysis Picture Recognition Buffer SpeechWriting Speech Writing GPC PGC Pictures/Objects Phoneme to Grapheme Conversion (non lexical)

Auditory Analysis AIL VIL Visual Analysis POLOOL Semantics Picture Analysis Picture Recognition Buffer SpeechWriting Speech Writing GPC PGC Pictures/Objects Phoneme to Grapheme Conversion (lexical)

Auditory Analysis AIL VIL Visual Analysis POLOOL Semantics Picture Analysis Picture Recognition Buffer SpeechWriting Speech Writing GPC PGC Pictures/Objects Non-semantic/direct lexical route

Auditory Analysis AIL VIL Visual Analysis POLOOL Semantics Picture Analysis Picture Recognition Buffer SpeechWriting Speech Writing GPC PGC Pictures/Objects Semantic lexical route

An Impairment at the level of OOL Surface Dysgraphia

Auditory Analysis AIL VIL Visual Analysis POLOOL Semantics Picture Analysis Picture Recognition Buffer SpeechWriting Speech Writing GPC PGC Pictures/Objects

RG (Beauvois and Derousne 1981) Spelling to dictation Non words100% Regular words 93% Irregular words 36% –High frequency 44% –Low frequency 19% Regularisation errors

An Impairment in Phoneme to Grapheme Conversion Phonological Dysgraphia

Auditory Analysis AIL VIL Visual Analysis POLOOL Semantics Picture Analysis Picture Recognition Buffer SpeechWriting Speech Writing GPC PGC Pictures/Objects

PR (Shallice 1981) Mild aphasia Good naming and comprehension Some phonological errors Writing real words to dictation: High frequency100% Low frequency 92% No effect of regularity. Able to use POL-OOL or semantic route.

PR: Repeating and Writing NONSENSE words 1 st repetition writing2 nd repetition CV17/206/2013/20 CVC19/202/2013/20 CVC (2)20/208/2020/20

Interim Conclusion Very marked lexical effect in writing to dictation (Words > Non Words) Lexical routes (via OOL) are intact Non lexical route (via PGC) is impaired Good repetition suggests PGC is site of difficulty

Writing and defining abstract words Correctly written Incorrectly written Good definition 213 Partial definition 249 Poor definition 68 Highlighted spelling via semantic route.

Multiple Impairments? Deep Dysgraphia

Deep Dysgraphia (Nolan and Caramazza 1982) Poor non word spelling (PGC impairment) Semantic errors in spelling Content words>function words Nouns>verbs Imageability effect Writing via an impaired semantic route

Auditory Analysis AIL VIL Visual Analysis POLOOL Semantics Picture Analysis Picture Recognition Buffer SpeechWriting Speech Writing GPC PGC Pictures/Objects

An impairment in semantics and Phoneme to Grapheme Conversion i.e. Spelling via the non-semantic lexical route

Non-semantic lexical route People able to spell a word without understanding the meaning AIL -> POL -> OOL

GE (Patterson 1986) Poor performance in Repetition Auditory comprehension (words and sentences) Reading aloud Spoken naming Written naming Good performance in: Minimal pairs Auditory lexical decision Some skills in writing to dictation

GE (Patterson 1986) Writing to Dictation: Non words34% High imag words57% Low imag words54% Regular words79% Irregular words79% Therefore not spelling via semantics Therefore not spelling via GPC

GE (Patterson 1986) GE can write words that he cannot understand: Writing words to dictation>90% Matching same spoken words to pictures 66%

The Story Central semantic impairment (poor comprehension and naming) Impaired PGC (poor non word writing) Writing uses POL to OOL

Auditory Analysis AIL VIL Visual Analysis POLOOL Semantics Picture Analysis Picture Recognition Buffer SpeechWriting Speech Writing GPC PGC Pictures/Objects

Peripheral Dysgraphias Graphic Motor Patterns Allograph Level Grapheme Level (Graphemic Buffer) Writing Temporary Store Assigning letter shapes Retrieving motor patterns NB Can co-occur with central dysgraphias

Buffer Deficits (eg Caramazza et al 1987) Letter deletions, substitutions, additions, transpositions No effect of frequency, lexical status, imageability or word class (although see Sage and Ellis 2004) Powerful effect of length May be position effects Similar performance across different tasks Interesting errors with double letters, eg sorella written as SORRELA (Italian for sister)

Allograph Impairments Oral spelling > written spelling Keyboard > writing Dissociations between upper and lower case are seen (eg Destreri et al 2000)

Motor Impairment Oral > written spelling Key board > written spelling Inability to write letter shapes (although may be able to describe them) Probably no effects of case Stroke errors, eg failure to dot i, cross t, additional strokes in letters Errors are similar to those made by normal writers when carrying out dual motor task and deprived of visual feedback (Ellis et al 1987)

Testing Writing Ask about writing pre stroke – literacy levels? Ask about writing since stroke Start with familiar items (name, address) Screening words (eg controlled for regularity, imageability, class, length) Attempt different tasks (copying, naming, writing to dictation). Difference? Attempt different modes of writing (pen, keyboard, anagram tiles)

Different Writing Approaches Semantic problem? Written naming with cues Correction of semantic errors Word to picture matching Categorisation ‘Semantic brainstorming’

Different Writing Approaches Impaired access to OOL? Naming with cues Anagram sorting Delayed copying Improving sound/letter correspondences, so person can self cue

Different Writing Approaches Buffer impairment? Copying then delayed copying Segmentation of words Hierarchical naming tasks from short to long words Error detection/ correction strategies

Different Writing Approaches Allographic/ Motor Impairment? Exploit alternative methods of writing (keyboard, oral spelling) Practice in tracing letter shapes Prosthesis to assist with motor aspects

Functional and Strategic Approaches Writing may be an alternative method of communication (e.g. where speech is more impaired than writing, see Robson et al 2001) Integrating impairment work with functional strategies May be specific writing activities that the person wants to resume Working on written messages (Robson et al 1998, 2001) Using computers with spell checkers! (Mortley et al 2001)