A Case Study Of Narrative Production In Primary Progressive Aphasia; Development And Application Of The Linguistic Communication Measure – Speech Sounds

摘要

This thesis is a longitudinal case study of the speech and language of a woman (BYR) with Primary Progressive Aphasia. The data analyzed are a series of Cookie Theft picture descriptions videotaped over the course of two years, two months. The Linguistic Communication Measure (Menn, Ramsberger u26 Helm-Estabrooks, 1994) and the Cantonese Linguistic Communication Measure (Kong and Law, 2004, CLCM) were previously used to analyze BYR’s narratives. These measures captured semantic and morphosyntactic information about the narratives but did not quantify the prominent sound production deterioration in BYR’s narrations. In order to capture all aspects of her speech and language deterioration during narration, a new measurement tool, the Linguistic Communication Measure - Speech Sounds (LCM-SS), was created.The principal index of the LCM-SS, the Index of Sound Error (ISouE), was designed to quantify phonetic and phonological errors differently than existing measures. Existing sound error measures are problematic because they either conflate phonemic and semantic errors as ‘paraphasic errors’ (CLCM; Shewan, 1988, SSLA), require counting individual phoneme repetitions (SSLA), or rate articulation on a subjective scale (SSLA; Boston Diagnostic Aphasia Exam, Goodglass u26 Kaplan, 1993). ISouE is defined as number of sound errors plus number of words/phrases with repetitions, divided by number of content units. ‘Sound errors’ are phonemic paraphasias, attempts at words with incorrect sounds that are eventually produced, and identifiable broken off words (‘cook jar’ for ‘cookie jar’). BYR’s phonemic and phonetic errors are exceedingly difficult to tease apart, partly due to increased motor involvement as her PPA progressed, and the measure considers them both to be ‘sound errors’.The LCM-SS showed that semantic, morphosyntactic and phonetic/phonological elements of BYR’s narratives changed over time. Lexical access appears to be negatively affected, but there is not a concurrent increase in semantic errors. Morphosyntactic richness of the narratives decreased, but the narratives did not become agrammatic and morphosyntactic errors remained low. Sound errors increased steadily over time indicating BYR had increasing impairment in phonetic/phonological aspects of production. The LCM-SS was tested for validity and reliability on BYR’s narratives. Results showed a high negative correlation (-0.95) between ISouE and overall goodness ratings, and a high positive correlation (0.93) between the Index of Communication Efficiency and the overall ratings. Intra-coder reliability for the LCM-SS was high (k = 0.97).The LCM-SS, incorporating the ISouE, is an objective, valid and reliable tool that successfully captures the degeneration in BYR’s speech and language that was missed by earlier measures. The ISouE avoids the problems of distinguishing phonemic and phonetic sound errors and of counting the number of repetitions. It may prove to be useful for tracking sound production progress or deterioration in other people with aphasia after more rigorous testing.