History of Aphasiology

1. Ling 411 – 03 History of Aphasiology 1. Early Workers 2. Broca, Wernicke, Lichtheim 3. Reactions to Connectionism 4. Goldstein, Luria and Geschwind 5. Recent and Current Workers

2. What is aphasia? http://www.youtube.com/watch?v=eZIWBmsqpxI :43 – 1:32

3. Outline of major historical periods • Early studies: Up to Broca • Broca, Wernicke, Lichtheim – Connectionism • The decades following Wernicke & Lichtheim • Goldstein, Luria, Geschwind • The return of connectionism • Present and recent past • Goodglass • Benson and Ardila • Paradis • Damasio • Psychologists • Poeppel and Hickock

4. 1. Early Studies From ancient Egypt to Broca

5. An Egyptian surgeon, ca. 3000 B.C. • “If you examine a man with a broken temple, … when you speak to him, he does not answer, he has lost his use of words.”

6. Hippocrates (ca. 400 BCE) "Men ought to know that from nothing else but the brain come joys, delights, laughter and sports, and sorrows, griefs, despondency, and lamentations. And by this, in an especial manner, we acquire wisdom and knowledge, and see and hear and know what are foul and what are fair, what are bad and what are good, what are sweet and what are unsavory ... And by the same organ we become mad and delirious, and fears and terrors assail us ... All these things we endure from the brain when it is not healthy ... In these ways I am of the opinion that the brain exercises the greatest power in the man."

7. Early European thinking • Aristotle • Heart is the center of intelligence • Brain is for cooling blood • Galen (Greek, 130(?) – 201(?) a.d.) • Dissected animals • Brain is center of thinking and feeling • Vesalius (16th century, worked on cadavers) • (next slide) • Steno (Late 17th century) • Brain is the seat of both thought and soul

8. Andreas Vesalius • 1514-1564 • Considered to be the father of modern anatomy • “De Fabrica Humanis Corpora” • New standard for medical art

9. Franz Joseph Gall • By early 1800’s, aphasia became a focus of intellectual speculation • Franz Joseph Gall (1758–1828) • Started career in Vienna, later moved to Paris • Localization of function • good idea! • Phrenology • bad idea! • Assumes localization of complex functions

10. Gall’s Phrenology Theory Wrong, of course! (Why?) Yet the idea of localization is a good one

11. Reactions to Gall • Pierre Flourens – Attacked Gall • The brain functions holistically • Supporters of Gall • Jean-Baptiste Bouillard (1825–1881) • Ernst Aubertin (son-in-law of Bouillard) • Pierre Gratiolet

12. A decades-long debate • Locationism vs. Holism • Started with reactions to Gall • Gall: a naïve locationist • At first, it was assumed that alllocationalism was necessarily naïve • The only alternative seen was holism • Debate flourished for decades • Mainly in France, England, Germany

13. Marc Dax • In unublished work of 1836 he anticipated the later major contribution of Broca • Probably influenced Broca

14. Jean-Baptiste Bouillard (France) • 1825-1881 • Improved Gall’s methods • Anticipated later theories • Did post-mortem exams of aphasics • Proposed left frontal lobe (sometimes right) as the locus of speech

15. Ernst Auburtin (France) • Son-in-law of Bouillard • Supported the theory of localization of brain functions in discrete brain areas • Presented an important paper in 1861 • Broca was in the audience • Broca invited Aubertin to examine one of his patients

16. 2. Broca, Wernicke, Lichtheim The rise of connectionism: A sophisticated form of locationalism

17. Pierre Paul Broca (French,1824-1880)

18. Pierre Paul Broca (1824–1880) • Heard important presentation by Auburtin in 1861 • Two days later, he got a patient who • Couldn’t talk • Had malfunction of right side of body • Died 5 days later • Broca performed autopsy • Found lesion in “third frontal convolution” • Second patient, also aphasic, also had lesion in inferior frontal gyrus

19. Broca 1861 Broca, Paul. 1861. Nouvelle observation d'aphémie produite par une lésion de la moitié postérieure des deuxième et troisième circonvolution Frontales gauches. Bulletin de la Société Anatomique 36.398-407.

20. Broca 1861 "The integrity of the third frontal convolution (and perhaps of the second) seems indispensable to the exercise of the faculty of articulate language ... I found that in my second patient the lesion occupied exactly the same seat as with the first – immediately behind the middle third, opposite the insula and precisely on the same side.”

21. Principal cortical gyri (schematic)

22. Pierre Paul Broca (cont’d) • One patient had right hemisphere damage, but no speech disturbance • In 1870’s, started localizing other functions • Did neuroanatomical studies of dogs to investigate localization hypotheses • Also recognized a different language disorder – “verbal amnesia” – but didn’t propose a location • Was criticized on the grounds that some aphasics didn’t have lesion in 3rd frontal gyrus

23. Broca’s major contributions • Cerebral dominance • “We speak with the left side of our brains” • Inferior frontal gyrus for speech production (“Broca’s area”*) • Localization of function based on convolutional anatomy *Broca did not himself propose this designation

24. Karl Wernicke (German, 1848-1905) The most im-portant figure in 19th century aphasiology

25. Karl Wernicke (1848-1905) • Studied neuroanatomy with Meinert in Vienna • Important paper published in 1874 (at age 26) • Generally supported Broca • Identified “Broca’s aphasia” as difficulty with speech production, especially of function words • Also identified a posterior language area

26. Wernicke’s posterior language area • In posterior superior temporal lobe • Important for speech comprehension • If damaged, comprehension impaired • If damaged, speech is repetitive • Patient is unaware of his errors • Locus of auditory images of words • Now known as Wernicke’s area

27. Two basic language areas Primary Somato- sensory Area Primary Motor Area Broca’s area Wernicke’s area Primary Auditory Area Primary Visual Area

28. Two basic language areas Primary Somato- sensory Area Primary Motor Area Phonological Recognition Phonological Production Primary Auditory Area Primary Visual Area

29. Wernicke: Connectionism • Proposed the theory of connectionism (with Lichtheim) • Involves localization of function, but in a more sophisticated form than predecessors • Accepted Meinert’s postulation of a fiber bundle connecting the two basic language areas – arcuate fasciculus

30. Arcuate Fasciculus Arcuate fasciculus Wernicke’s area Broca’s area

31. Wernicke: Connectionismand the arcuate fasciculus • Wernicke learned about the arcuate fasciculus from Meinert in Vienna • Predicted “Conduction Aphasia” • Would result from damage to arcuate fasciculus • Such a patient would be unable to transmit auditory identification to speech production area • Hence, impaired repetition • Later, he encountered a patient with just this problem

32. Ludwig Lichtheim (German, 1845-1928) • Worked with Wernicke • Proposed a connectionist-locationist scheme with now-famous diagram, 1885 • Accepted by Wernicke • The birth of connectionism • This scheme was widely criticized for several subsequent decades • Revived by Norman Geschwind in 1960’s

33. The Wernicke-Lichtheim model (1885) A – Auditory M – Motor B – Ideation Numbers indicate areas in which disconnection would produce distinct disorder From Lichtheim 1885

34. The Wernicke-Lichtheim model (1885) Several different areas Arcuate fasciculus Broca’s area Mouth region of primary motor area Wernicke’s area Primary auditory area

35. Hickok’s revised diagram (Gregory Hickock, 2000) Conceptual Representations Linguistic Representation Sensory-Motor Periphery M A

36. Wernicke and Connectionism “Based on on his discoveries and those of Broca, Fritsch, and Hitzig, Wernicke proposed (1876) that only the most basic mental functions, those concerned with simple perceptual and motor activities, are localized to single areas of the cortex, and that more complex intellectual functions result from interconnections between several functional sites. In placing the principle of localized function within a connectionist framework, Wernicke appreciated that different components of a single behavior are processed in different regions of the brain. He thus advanced the first evidence for the idea of distributed processing, which is now central to our understanding of brain function.” (Kandel et al. 1995:13) Big lesson – Remember this!

37. 3. The Decades following Wernicke & Lichtheim From Marie to Goldstein (Benson & Ardila include Goldstein and Luria in this third period)

38. Jules Dejerine (French) • 1901: Accepted basic ideas of Wernicke and Lichtheim • But rejected the concept center depicted in their diagram – no anatomical basis • Added account of reading problems: alexia • Visual-verbal zone in left angular gyrus

39. Diverse Views after Wernicke & Lichtheim • Pierre Marie (France) • Jules Dejerine (France) • J. Hughlings Jackson (England) • Henry Head (England) • Kurt Goldstein (Germany) • Aleksandr Luria (Russia) • But largely in agreement with Wernicke’s basic ideas Color Code: Attacked Wernicke Supported Wernicke Independent innovator

40. 4. Goldstein, Luria, Geschwind: The return of connectionism

41. Kurt Goldstein (1878-1965) • German • Studied with Wernicke • Influenced by Gestalt psychology (Koffka 1935) • Adopted a “holistic” approach • Became the best-known spokesman for this approach • Important publication in 1948 • Criticized the Wernicke-Lichtheim view of conduction aphasia • Not the arcuate fasciculus but a central area • Proposed the term ‘Central Aphasia’ • Now we see that there are really two (or more?) kinds of conduction aphasia

42. Another basic language area? Central Sulcus Central area Broca’s area Wernicke’s area Primary Auditory Area Primary Visual Area

43. Luria’s positionaccording to Benson & Ardila Luria … took a midway stance between the localizationist and holistic approaches. He considered language to be a complex functional system, requiring many different steps in both comprehension and production; simultaneous participation of multiple cortical areas would be required for language processing. Although each cortical area performs a specific process, it also participates in different functional systems. Thus, the first temporal gyrus participates in phoneme discrimination, and its damage causes difficulty in all functional systems requiring phoneme discrimination… Benson & Ardila 1996:19-20 Question: Is this really a “midway stance”?

44. Good and bad localizationist models • Bad (e.g., Gall’s phrenology) • Each local center does a fairly large job, all by itself • Good (e.g. Wernicke-Lichtheim) • Each local center does a very small job • Large jobs get done by the operation of several or many such local centers working together, partly in serial, partly in parallel — distributed processing • A local center can participate in several different kinds of larger jobs, depending on what other centers are working together with it

45. Norman Geschwind (1926-1984) • Born in New York City • Trained: Harvard medical school and London’s National Hospital • Career: • Boston VA hospital • Chief of neurology • Boston University, neurology • Established Boston U Aphasia Research Center • Trained a generation of leading neurologists • Incl. Goodglass, Benson, Damasio • Revived the Wernicke-Lichtheim theory

46. Norman Geschwind on Wernicke (1966) Wernicke’s reasoning was simple. He applied Meynert’s teaching on the fiber tracts of the brain to the problem of aphasia. The phrenologists, he argued, had been wrong in their attempt to localize such complex mental attributes as magnanimity or filial love; what was actually localizable were much simpler perceptual and motor functions. All the complex array of human intellectual attributes must somehow be woven from these few threads of different texture. The cortex could … provide two means of achieving this higher integration: it could store sensory traces in cells … and, by means of association fiber tracts, it could link together different parts of the system.

47. Norman Geschwind on Wernicke (1966) (cont’d) Meynert had already pointed out that what lay anterior to the fissure of Rolando was motor in function, what lay behind it was sensory. It seemed most reasonable to assume that traces of sensory impressions or of motor patterns should somehow be stored in regions adjacent to the appropriate elementary zones in the cortex.

48. Norman Geschwind on Wernicke (1966) (cont’d) The application to speech was immediate. Hitzig had already shown that at the lower end of the Rolandic cortex was a zone which, when stimulated on one side, led to bilateral movements of the mouth and the tongue. It was reasonable to assume that immediately in front of this zone lay a region where patterns of articulatory movements might be stored. This was exactly where Broca had placed the lesions in his cases, a localization repeatedly to be confirmed.

49. Norman Geschwind on Wernicke (1966) (cont’d) Meynert had asserted that the central end of the acoustic pathways lay in the vicinity of the Sylvian fissure. Thus it was reasonable to assume that traces of words should be stored near this zone. If this were the case, then an aphasia with loss of comprehension should result from lesions in this neighborhood. Necropsy of the patients recorded in Wernicke’s paper amply confirmed these hypotheses.

50. Intellectual lineagesLeading Aphasiologists Wernicke Lichtheim Goldstein Luria (Moscow) Ardila Geschwind (Boston) Goodglass Benson Damasio