The first three years of human life are essential for the development and acquisition of speech and language skills. Skills which, in principle, will accompany the person for the rest of his life.
But there are cases when this ability is truncated due to injuries in certain areas of the brain; thus appearing aphasic disorders which lead to deficits like agrammatism, which will be discussed throughout this article.
What is agrammatism?
Agrammatism is considered to be an alteration of the language specific to aphasias. Its most notable characteristic is that the person presents a speech deficit which results in failures related to morphological structures. In other words, it presents a great difficulty in joining words in a sentence forming syntactically appropriate sequences.
This failure usually occurs in patients diagnosed with Broc Aphasia. The fact that it manifests itself as a difficulty in creating syntactic constructions makes it one more symptom within this type of aphasia.
However, after the development of cognitive neuropsychology in the mid-twentieth century, it became clear that agrammatism was much more complex and could be observed in patients who did not meet the other requirements of the classical diagnosis of drilling aphasia. . In addition, the individual differences between the patients were more than noticeable.
At this very moment, a huge debate has erupted as to whether agrammatism could be considered a validated aphasic category. This controversy still persists today, with disagreements between those who advocate agrammatism as an aphasic syndrome and those who oppose its validity as such.
But what are aphasias?
According to the general definition of aphasia, it is a language disorder caused by brain damage in any area of language, and which renders the person unable to communicate by speaking, writing and even mime.
The causes of aphasia can be:
- traumatic brain injury
- 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 fluent verbal production and the use of short, grammatical sentences produced with enormous effort and in a prosodic manner. .
There are a number of symptoms which are more or less consistent in the understanding and production of agrammatic patients.
1. Symptoms associated with tongue production
These are the most common symptoms associated with speech.
1.1. Problems with grammatical morphemes
This symptom is reflected in the selective omission of free and linked grammatical morphemes. However, this symptom as such is more typical of English speaking patients, who add inflections to words. But in languages like Spanish or Italian this is not possible, because inflections are added to the roots.
For example, in English you can omit -a in the word walk, but a Hispanic person cannot omit -ía in food, because 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 language-related grammatical morphemes have been considered typical of agrammatism.
1.2. Average sentence length
One of the symptoms observed in agrammatism, but which is not always present, is the reduced duration of oral emission. In which the patients express themselves with expressions and sentences much shorter than usual.
1.3. Noun-verb dissociation
Another symptom that people with agrammatism present is that of difficulty accessing verbal forms. In other words, patients omit or nominate the main verbs of the sentences.
This deficit occurs in both structured tasks and spontaneous speaking tasks.
1.4. Difficulties in constructing sentences
These patients use subject-verb-object structures; presenting enormous difficulty in sentences of greater syntactic complexity. This symptom is the consequence of a lexical deficit which affects the correct selection of verbs.
1.5. Problems in word order
It is considered one of the most characteristic features of agmatism. Agrammatic patients find it difficult to correctly order verbal expressions in an understandable order, especially in the production of passive sentences or with structures other than usual.
2. Symptoms associated with language comprehension
Until the 1970s, agrammatism was considered to be an exclusive deficit in language production, without noticing whether language comprehension was impaired.
But research into the auditory comprehension of grammarians has found that these patients have difficulty in specific syntactic components, Which prevents them from understanding certain sentence structures. It is specified that the alteration is selective because the patients present a great deterioration in the comprehension of certain sentences, but the rest of the syntax remains intact.
Assessment and diagnosis
Despite the complexity of this deficit, there is no specific evidence to assess it; being the most widely used own aphasia assessment tests.
currently Boston and Barcelona verbal expression subtests are used: Narration of an event and description of an image. Assessment includes transcription of the patient’s speech with subsequent assessment of lexical poverty, sentence quality, misuse of morphemes and lexemes, or incorporation of functional words.
1. Boston Aphasia Diagnostic Test (Goodlas & Kaplan, 1972)
This is the most widely used test given its ease of administration. It contains a specific vocabulary assessment test and an abbreviated format for rapid patient screening.
2. Test Barcelona (Peña-Casanova, 1990)
This test assesses all cognitive mechanisms related to language. It is characterized by the fact that it is an extensive and complicated test but consisting of an abbreviated format.
Processing: HELPSS method
The beginnings of this method were based on certain studies of agmatism, in which techniques of supplementing the stories in patients with Broca’s aphasia and agramáticos were used.
Likewise, this method incorporated different levels of difficulty into the storytelling activities. Thus, the HELPSS methodology comprises a succession of stages hierarchized on two levels of difficulty: A and B; working, in addition, with eleven types of sentences:
- Transitive imperative
- Intransitive imperative
- Transitional declaration
- Interrogative pronoun
- Transitional declaration
- intransitive declaration
- Direct and indirect object
- Yes or no questions
- subordinate clauses
Each type of sentence is worked with two levels of difficulty, presenting twenty stories with different examples of the previous types of sentences, which are illustrated with pictures but not with written sentences.
At level A, the professional must tell a story that ends with the image of the professional. The patient is then asked a question to get an answer from an example. When the person achieves 90% accuracy in a sentence type, they move up to level B.
During level B, the example sentence is omitted; ask the patient to construct the sentence in an authentic way.