Pragmatics in Neurogenic Communication Disorders

Pragmatics in Neurogenic Communication Disorders

Related Pergamon Books

MICHEL PARADIS MICHEL PARADIS FRANCO FABBRO K. JASZCZOLT and K. TURNER J. L. MEY

Foundations of Aphasia Rehabilitation Apects of Bilingual Aphasia Concise Encyclopedia of Language Pathology Contrastive Semantics & Pragmatics, 2-Volume Set Concise Encyclopedia of Pragmatics

Related Pergamon Journals

Journal of Communcation Disorders Editor: Theodore J. Glattke Journal of Fluency Disorders Editor: G. J. Brutten Journal of Neurolinguistics Editor: J. C. Marshall Journal of Pragmatics Editor: J. L. Mey Language Sciences Editor: Nigel Love Neuropsychologia Editor: S. D. Iversen Free specimen copies of journals available on request

PRAGMATICS IN NEUROGENIC COMMUNICATION DISORDERS

Edited by

MICHEL PARADIS McGill University

INTERNATIONAL ASSOCIATION OF LOGOPEDICS AND PHONIATRICS

PERGAMON

U.K.

Elsevier Science Ltd, The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, U.K.

U.S.A.

Elsevier Science Inc., 660 White Plains Road, Tarrytown, New York 105915153, U.S.A.

JAPAN

Elsevier Science Japan, Tsunashima Building Annex, 3-20-12 Yushima, Bunkyo-ku, Tokyo 113, Japan Copyright © 1998 Elsevier Science Ltd All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means: elecronic, electrostatic, magnetic tape, mechancal, photocopying, recording or otherwise, without permission in writing from the publishers First edition 1998 Library of Congress Cataloging in Publication Data Pragmatics in neurogenic communication disorders/edited by Michel Paradis. p. cm. "International Association of Logopedics and Phoniatrics." Includes bibliographical references and indexes. ISBN 0-08-043065-1 1. Aphasia. 2. Pragmatics. I. Paradis, Michel. II. International Association of Logopedics and Phoniatrics. [DNLM: 1. Aphasia—etiology. 2. Aphasia—physiopathology. 3. Brain Diseases—complications. 4. Communication. WL 340.5 P898 1998] RC425.P726 1998 616.85'52—dc21 DNLM/DLC for Library of Congress 98-6486 CIP ISBN 0-08-043065-1

Printed and bound in Great Britain by Galliard (Printers) Ltd, Great Yarmouth

PII: S 0911-6044(98)00022-0

Publishers' Preface In recognition of the current importance of this topic, this collection was also published as Volume 11 (1-2) of the Journal of Neurolinguistics

This page intentionally left blank

Contents Introduction The other side of language: Pragmatic competence

M. Paradis

I. Impairment of discourse 1. 2. 3. 4.

5.

Pragmatic breakdown in patients with left and right brain damage: Clinical implications R. L. Bloom & L. K. Obler

11

Conversational abilities in patients with right hemisphere damage Y. Chantraine, Y. Joanette, & B. Ska

21

Conversing in dementia: A conversation analytic approach L. Perkins, A. Whitworth, & R. Lesser

33

Discourse in fluent aphasia and Alzheimer's disease: Linguistic and cognitive considerations S. Bond Chapman, A. Peterson Highley, & J. L. Thompson

55

Coherence and informativeness of discourse in two dementia types M. Laine, E. Vuorinen, M. Laakso, & J. Rinne

79

II. Other pragmatic deficits 6.

Affective Prosodic disturbance subsequent to right hemisphere stroke: A clinical application R. T.Wertz, C. R. Henschel, L. L. Auther, J. R. Ashford, & H. S. Kirshner

89

The Role of emotion in the linguistic and pragmatic aspects of aphasic performance M. Perlman Lorch, J. C. Borod, & E. Koff

103

Literal vs. figurative meaning in patients with closed-head injury K. L. Chobor, & A. Schweiger

119

Shifting the burden to the interlocutor: Compensation for pragmatic deficits in signers with Parkinson's disease J. Kegl & H. Poimer

137

10. Pragmatics in frontal lobe dementia and primary progressive aphasia J. B. Orange, A. Kertesi, & J. Peacock

153

7. 8. 9.

vi

Contents

III. Compensatory strategies 11. Pragmatics in the absence of verbal language: Descriptions of a severe aphasic and a linguistically deprived adult N. F. Dronkers, C. A. Ludy, & B. B. Redfern

179

12. The use of gestures as a compensatory strategy in adults with acquired aphasia compared to children with specific language impairment B. Fex, & A.-C. Månsson

191

13. Relationship between language impairment and pragmatic behavior in aphasic adults J. A. Avent, R. T. Wertz, & L. L Auther

207

14. A cross language analysis of conversation in a trilingual speaker with aphasia L. Springer, N. Miller, & F. Bürk

223

Author index

243

Subject index

253

Pergamon

866

List o f Contributors John S. Ashford, Veterans Administration Medical Center, Nashville, Tennessee, U.S. A. Linda L. Auther, Veterans Administration Medical Center, Nashville, Tennessee, U.S.A. Jan R. Avent, Department of Communicative Sciences and Disorders, California State University, Hayward,California, U.S.A. Ronald Bloom, Speech-Language-Hearing Sciences, Hofstra University, Hempstead, New York, New York, U.S.A. Joan C. Borod, Department of Psychology, Queens College, and Department of Neurology, Mount Sinai Medical Center, CUNY, New York, New York, U.S.A. Frauke Bürk, Speech-Language Therapy, Sanderson Hospital, Newcasde-upon-Tyne, Great Britain. Sandra Bond Chapman, Callier Center for Communication Disorders, University of Texas, Dallas, Texas, U.S.A. Karen L. Chobor, Department of Neurology, New York University Medical Center, New York, New York, U.S.A. Nina Dronkers, Veterans Administration Northern California Health Care System and University of California, Davis, California, U.S.A. Bibi Fex, Logopedic Unit, ENT Department, Helsingborg Hospital, Helsingborg, Sweden. Constance R. Henschel, Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A. Amy Peterson Highley, Callier Center for Communication Disorders, University of Texas, Dallas, Texas, U.S.A. Judy Kegl, Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, NJ, U.S.A Andrew Kertesz, Department of Clinical Neurological Sciences and Disorders, St. Joseph's Health Centre, University of Western Ontario, London, Ontario, Canada Howards. Kirshner, Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A. Elissa Koff, Department of Psychology, Wellesley College, Wellesley, Massachusetts, U.S.A. Minna Laakso, Department of Phonetics, University of Helsinki, Helsinki, Finland. Matti Laine, Department of Neurology, University of Turku, Turku, Finland. Ruth Lesser, Department of Speech, University of Newcasde-upon-Tyne, United Kingdom. Carl A. Ludy, Veterans Administration Northern California Health Care System, Davis, California, U.S.A.

viii

Contributors

Jennifer E. Peacock, School of Communication Sciences and Disorders, University of Western Ontario, London, Ontario, Canada Marjorie Perlman Lorch, Applied Linguistics, Birkbeck College, University of London, London, Great Britain. Ann-Christin Månsson, Logopedic Unit, ENT Department, Helsingborg Helsingborg, Sweden.

Hospital,

Nick Miller, Department of Speech, University of Newcastle-upon-Tyne, United Kingdom. LoraineK. Obler, Program in Speech and Hearing Sciences, CUNY Graduate School, New York, New York, U.S.A. Joseph B. Orange, School of Communication Sciences and Disorders, University of Western Ontario, London, Ontario, Canada. Michel Paradis, Department of Linguistics, McGill University, and Cognitive Neuroscience Laboratory, Universite du Québec á Montreal, Montreal, Canada Lisa Perkins, Department of Speech, University of Newcastle-upon-Tyne, United Kingdom. Howard Poizner, Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, NJ, U.S.A Brenda B. Redfern, Veterans Administration Northern California Health Care System, Davis, California, U.S.A. Juha Rinne, Department of Neurology, University of Turku, Turku, Finland. Avraham Schweiger, Department of Speech and Hearing Sciences, CUNY Graduate Center, New York, New York, U.S.A. Luise Springer, Lehranstaltfiir Logopädie, RWTH Aachen, Germany. Jennifer L. Thompson, Callier Center for Communication Disorders, University of Texas, Dallas, Texas, U.S.A. Elina Vuorinen, Pulsin Neurocenter, Turku, Finland. Robert T. Wertz, Veterans Administration Medical Center, and Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A. Anne Whitworth, Department of Speech, University of Newcastle-upon-Tyne, United Kingdom.

_

Pergamon

J. Neurolinguistics, Vol. 11, Nos 1-2, p. ix-x, 1998 Published by Elsevier Science Ltd. Printed in Great Britain

0911-6044/98 $19.00+ 0.00

PII: S 0911-6044(98)00018-9

Preface At its August 1995 meeting in Cairo, Egypt, on the occasion of the XXIIIrd Congress of the International Association of Logopedics and Phoniatrics (IALP), the Aphasia Committee undertook to prepare a report on pragmatics in neurogenic communication disorders to be presentedat the XXIVth IALP congress in Amsterdam in August 1997. The Longman Dictionary of Applied Linguistics defines pragmatics as the study of the use of language in communication, particularly the relationships between sentences and the contexts and situations in which they are used (Richards, Platt, & Weber, 1985). Each member of the Aphasia Committee set out to investigate pragmatics from one of two angles: (1) as a compensatory strategy for individuals whose implicit linguistic competence has been impaired, and (2) as an element affected by a variety of neurogenic conditions, from focal damage to the right or the left hemisphere to various types of progressive dementias. A first draft of these investigations was discussed by the members of the Aphasia Committee at a meeting held in Montreal, Canada, on 1 and 2 July 1997. After a thorough discussion of each contribution, each author wrote a final report which is published in the present volume. Hence, all contributions report on research conducted specifically for this publication over the past three years by members of the IALP Aphasia Committee and their collaborators. The purpose of this work is to focus the attention of language pathologists and neurolinguists around the world on the importance of pragmatics in verbal communication and its disorders. The various contributions illustrate why pragmatics might in fact be consideredmore critical than morphosyntax for verbal communication. On the one hand, it can always be used by speakers to overcome gaps in their linguistic competence, as is routinely done by children, second language learners, and aphasic patients. On the other, whereas languages with the relevant structural information can always take pragmatic cues into account, languages with no morphosyntactic marking for certain concepts, such as gender in pronominal reference, for instance (e.g., spoken Chinese), must rely solely on discourse context and other pragmatic cues. In both cases, neither grammar nor pragmatics is entirely sufficient but both are necessary for arriving at an interpretation for every utterance in normal verbal communication. Chomsky (1980) explicitly recognized that "the system of language [i.e., implicit linguistic competence, the grammar] is only one of a number of cognitive systems that interact in the most intimate way in the actual use of language" (p. 188). Pragmatic competence comprises two major aspects that will be considered here: (a) the organization of discourse, that is, when and how utterances are appropriately used in verbal interactions, and (b) the meaning derived from aspects of language use other than the grammar, such as inferences from the situational context, paralinguistic phenomena (affectiveprosody, gestures, facial expressions) or general knowledge. Such inferences, it is reckoned, are necessary to interpret not only jokes, sarcasm, indirect speech acts and nonstereotyped metaphors, but every single utterance, if only to determine whether it is to be taken literally or not. After a discussion of the historical and theoretical background for the study of pragmatics in neurogenic communication disorders, a first set of five papers examine ways in which the pragmatic aspects of discourse are disordered by neurogenic pathologies; a second group of five papers investigate pragmatic deficits in communication disorders of varying etiology; and a third and last group of four papers consider the use of pragmatics as a compensatory strategy for patients with aphasia.

x

Preface

These contributions, which appear in the third volume published since 1993 by the IALP Aphasia Committee, are simultaneously published in a special issue of the Journal of Neurolinguistics (1998), volume 11, numbers 1 and 2.

Acknowledgments Thanks are due to Lara Riente for her careful copy-editing of the text and the production of the camera-ready copy. Dr. Zofia Laubitz revised the texts contributed by the nonnative speakers of English. The research was supported in part by the Quebec Ministry of Education FCAR grants 92ER1050 and 96ER0404 and the Social Sciences and Humanities Research Council of Canada grant 410-94-0770.

References Chomsky, N. (1980). Rules and representations. Oxford: Basil Blackwell. Richards, J., Platt, J., & Weber, H. (1985) Longman Dictionary of Applied Linguistics. Harlow, UK: Longmans.

J. Neurolinguistics, Vol. 11, Nos 1-2, p. 1-10, 1998 ® 1998 Published by Elsevier Science Ltd. All rights reserved Printed in Great Britain 0911-6044/98 $19.00 + 0.00

PII: S 0911-6044(98)00001-3

The other side of language: Pragmatic competence MichelParadis Department of Linguistics, McGill University Abstract—Language pathology has traditionally been concerned with deficits in left-hemisphere-based linguistic competence, namely, in phonology, morphology, syntax and semantics. It has become increasingly apparent over the past twenty years that linguistic competence is not sufficient for normal verbal communication. Right-hemisphere-based pragmatic competence is at least equally necessary. As a result, on the one hand, neuropsychologists have been investigating pragmatic deficits, and on the other, language pathologists have been using aphasic patients' preserved pragmatic abilities to help them compensate for their deficits in linguistic competence. From the viewpoint of linguistic theory, there is now an external justification for treating sentence grammar independently of pragmatics.

As defined by Chomsky (1980), grammar characterizes the properties of sentences, but the production and interpretation of sentences by a speaker makes use of much else including, in particular, "pragmatic competence" (p. 206). Generative grammars, through their successive mutations over the past 40 years (e.g., from transformational to government and binding to the minimalist program), have been concerned with (extralinguistic context-independent) sentence grammar. Linguistic competence, as described by Chomsky (1965) is the implicit knowledge of the speaker-hearer's [sentence] grammar. The automatic, unconscious use of this linguistic competence is what allows speaker-hearers to produce and understand sentences. In the normal use of language, various additional cognitive entities have been recognized either as necessary (e.g., conceptual and episodic memory, the speaker's "encyclopaedia", i.e., that which the speaker speaks about) or as placing constraints on the use of linguistic competence (e.g., short-term memory constraints, attention span limitations, etc.). Moreover, in the normal use of language, in addition to the interpretation of the literal meaning of sentences, a discourse grammar, including rules of presuppositions and inference, and in general any extra-sentential context-dependent phenomena, is required. Sociolinguistic rules, which determine the appropriate choice among the various possible structures available in linguistic competence, are equally necessary. Paralmguistic competence is likewise required, comprising the use of intonation, gestures, and anything that serves to specify the meaning of the sentencesuch as whether it is meant as a sarcastic remark or a compliment, an indirect request or a factual question, whether it is to be taken with a figurative, metaphoric, idiomatic meaning or at face value. Indeed, we may estimate that more than half of what we say is not literally what we mean—at least not entirely. Most of the time, we mean more than what we say, or something different than what we actually say, or even the opposite of what we say. Not that we are particularly devious or deliberately deceptive, but this is simply the way language works in communication. We rarely state everything that we mean, leaving out whatever we consider to be obvious to the listener, often in the form of an inference (e.g., in the statement, "Bill drove John to the hospital—He had a broken leg", there is no need

2

M Paradis

to specify that John, not Bill, had the broken leg for reasons of inference from general knowledge: people with broken legs do not usually drive friends to the hospital, though the opposite is not uncommon). Often we say something different from what we mean, as in the use of figurative speech (a dirty look), idiomatic expressions (she's got him eating out of her hand), metaphors (the customs officer was a brick wall), and indirect speech acts ("Is there any salt on the table?" uttered at the dinner table after sipping the first spoonfuls of one's soup, is not interpreted as a question, but as an obvious request to pass the salt). The illocutionary force of indirect speech acts and the meaning of idiomatic expressions are so immediately obvious that their literal interpretation is a recurrent theme in newspaper comics (Dagwood to Blondie on her way to the kitchen: "If you happen to see a turkey sandwich in there, with lettuce, pickles and mayonnaise on it, would you bring it to me?" Blondie, coming back: "I didn' t see one". Idiomatic expressions: Hägar: "Im so hungry I could eat a horse." Waiter: "Rare, medium or well done?"). Sometimes we mean the opposite of what we say (irony, sarcasm) although what we mean is obvious to our interlocutor because of the tone of voice and/or concurrent circumstances (e.g., "That's a fine job!" uttered in the presence of a spectacularly bad performance). There is no doubt that the statement "the cat is on the mat" will be unambiguously interpreted as a warning when shouted at someone who is about to open the door; as a scolding if the cat's owner was told in no uncertain terms that it was all right to let the cat in the house, as long as it did not shed its hair on the carpet; and as a congratulatory remark if the cat's owner has been training the cat for days to lie on the mat, not on the sofa. In the literature on linguistics and the pathology of communication, there are at least two clearly distinct domains subsumed under the term "pragmatics": discourse structure and nonliteral meanings. The two domains may or may not share a single source, but both have traditionally been considered to constitute pragmatics and, more interestingly, both have been reported to be vulnerable to right hemisphere damage, frontal lobe lesions and schizophrenia, while relatively preserved in the context of dysphasia (Pierce & Wagner, 1985). Whether discourse analysis and the respect of conversational maxims are to be subsumed under the term "pragmatics", as two of its major components, or whether the two areas may be considered distinct, albeit with some possible overlap, is a decision contingent upon the level of abstraction of the analyst's perspective and theoretical framework. The common denominator seems to be the necessity to rely on context in order to derive an interpretation. This context can be situational (including paralinguistic cues), but also discursive (including structure and contents, as well as turn-taking and the like, from which inferences and implications must be made). Over the past century, damage to specific areas of the left cerebral hemisphere (LH) has been reported to disrupt the comprehension and/or production of various aspects of phonology, morphology, syntax, and the lexicon. In addition to mild symptoms of the same type subsequent to right hemisphere (RH) lesions in sites homologous to the LH classical language areas in some patients (Joanette, 1980; Joanette, Lecours, Lepage, & Lamoureux, 1983; Joanette, Goulet, & Hannequin, 1990), clear deficits of a different nature, affecting the comprehension and production of humor, affect, and various aspects of the nonliteral interpretation of utterances, have been reported over the past 20 years or so (Hier & Kaplan, 1980; Dwyer & Rinn, 1981; Ross, 1981, 1984, 1993; Brownell, Michel, Powelson, & Gardner, 1983; Foldi, Cicone, & Gardner, 1983; Gardner, Brownell, Wapner, & Michelow, 1983; Brookshire& Nicholas, 1984; Heilman, Bowers, Speedie, & Costlett, 1984; Hirst, LeDoux, & Stein, 1984; Tompkins & Mateer, 1985;

The other side of language

3

Bihrle, Brownell, Powelson, & Gardner, 1986; Brownell, Potter, Bihrle, & Gardner, 1986; McDonald & Wales, 1986; Foldi, 1987; Roman, Brownell, Potter, Seibold, & Gardner, 1987; Bihrle, Brownell & Gardner, 1988; Brownell, 1988; Weylman, Brownell, Roman, & Gardner, 1989; Brownell, Simpson, Birhle, Potter, & Gardner, 1990; Joanette & Brownell, 1990, 1993; Joanette, Goulet, & Hannequin, 1990, 1993; Kaplan, Brownell, Jacobs, & Gardner, 1990; Molloy, Brownell, & Gardner, 1990; Brownell, Carroll, Rehak, & Wingfield, 1992; Lalande, Braun, Charlebois, & Whitaker, 1992; Rehak, Kaplan, & Gardner, 1992; Rehak, Kaplan, Weylman, Kelly, Brownell, & Gardner, 1992; Brownell, Gardner, Prather, & Martino, 1995; Bara, Tirassa, & Zettin, 1997; Dipper, Bryan, & Tyson, 1997). Deficits secondary to RH damage thus typically involve those aspects of language use other than the ones involved in the literal interpretation of (contextindependent) sentences. More specifically, patients with RH damage have been variously shown to be insensitive to: connotative meaning (Brownell, Potter, Michelow, & Gardner, 1984); figurative speech, even when supportive contextual cues are available (Myers & Linebaugh, 1981); metaphors (Gardner, Ling, Flamm, & Silverman, 1975; Winner & Gardner, 1977; Brownell, Potter, Michelow, & Gardner, 1984; Bryan, 1988; Brownell, Simpson, Bihrle, Potter, & Gardner, 1990; Tompkins, 1990); idioms, even familiar ones (Weylman et al., 1989; Tompkins, Boada, & McGarry, 1992); the emotive meaning of words and emotions that have to be inferred from context (Cicone, Wapner, & Gardner, 1980; Brownell et al., 1984; Ross, 1984; Cancelliere & Kertesz, 1990; Ostrove, Simpson, & Gardner, 1990; Tompkins, 1991; Bloom, Borod, Obler, & Gerstman, 1992; Borod, Andelman, Obler, Tweedy, & Welkowitz, 1992); and indirect speech acts (Foldi, 1987; Stemmer, 1994). Many have been reported not to be able to use prosody to interpret (or convey) emotional content (Weintraub, Mesulam, & Kramer, 1981; Heilman, Bowers, Speedie, & Coslett, 1984; Shapiro & Danly, 1985; Tompkins & Flowers, 1985; Tompkins & Mateer, 1985; Schlanger, Schlanger, & Gerstman, 1986; Ross, Edmondson, Seibert, & Homan, 1988; Alexander, Benson, & Stuss, 1989; Behrens, 1989; Bryan, 1989; Bowers, Coslett, Bauer, Speedie, & Heilman, 1987; Cancelliere & Kertesz, 1990; Cohen, Prather, Town, & Hynd, 1990). Patients with RH damage also fail to understand the moral, punchline, theme, or main point of a story (Gardneret al., 1975; Brownell et al., 1986; Bryan, 1988; Hough, 1990; Schneiderman, Murasugi, & Saddy, 1992) and have problems in the organization of discourse (Delis, Wapner, Moses, & Gardner, 1983; Rehak, Kaplan, & Gardner, 1992; Rehak, Kaplan, Weylman, Kelly, Brownell, & Gardner, 1992). Overall, these patients seem to have difficulty in using contextual information to interpret discourse. However, the role of the RH in language processing has not been investigated as thoroughly as that of the LH. Thus, whereas deficits in implicit linguistic competence have long been commonly referred to as aphasia (or, more etymologically accurate, and still current in British Fjiglish, dysphasid) there is no label to refer to impairments in the ability to infer what is meant from the context in which something is said. I propose to use the term dyshyponoia, from the Greek vnovo