由汉语失语症病人叙述句的语调表现看“呼吸群理论”及“倾斜理论”
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•言语呼吸障碍评估的原理及方法1 言语与呼吸的关系言语是口语表达的过程,通过呼吸、发声、构音3个系统的协调运动实现。
具体过程为贮存在肺、气管与支气管内的气体,经过规律的呼气运动排出体外的过程中,在上呼吸道内形成气流,当该气流到达声门处时,经过位于喉部的声带,带动声带产生振动,行成一系列脉冲信号(声门波);通过声道的共鸣作用,形成具有适当形态的声波,最终由嘴和鼻发出言语信号(声波)。
可见,呼吸系统是言语产生的动力源,其核心为肺的运动。
2 言语呼吸的特点言语是在呼气的过程中产生的。
在言语过程中,需要瞬间吸入大量的气体并维持平稳的呼气,用较小的气流来维持足够的声门下压,这种呼吸调节过程要求呼气运动与吸气运动之间相互协同和拮抗,即呼吸支持。
因此,呼吸支持成为各种发音的基础。
言语呼吸不仅在吸气时需要吸气肌群主动收缩,而且在呼气时也需要腹部肌群稳健地收缩,以维持充足的声门下压,继而支持发声活动。
因此,与平静呼吸相比,言语呼吸需要瞬间吸入更多的气体,提供更多的呼吸支持,以维持足够的声门下压,从而获得言语的自然音调、响度以及丰富的语调变化。
3 言语呼吸障碍的分型及发病机理呼吸系统及发声系统存在病变,均可导致言语呼吸障碍。
其主要症状为说话气短、吃力、异常停顿、声音粗糙、病理性硬起音或气息音等。
根据其产生机理的不同,言语呼吸障碍可以分为呼吸方式异常、呼吸支持不足和呼吸与发声不协调3种。
3.1 呼吸方式异常呼吸方式异常主要指胸式呼吸,即呼吸过程中肺运动主要通过胸廓前后径的变化来实现,言语过程中常常出现抬肩吸气、胸廓明显起伏等临床表现。
正常的肺运动是通过肋骨与肋间肌、膈肌、肺以及腹部肌群4部分协同进行的。
无论是平静状态下的生理腹式呼吸或是言语腹式呼吸,均主要通过膈肌收缩(75%)来扩大胸腔的上下径,肋间外肌收缩(25%)来扩大前后左右径。
当言语呼吸只依靠扩大胸腔的前后左右径(即胸式呼吸),而非扩大胸腔的上下径(腹腔隆起)提供发声动力时,则违背了言语呼吸的生理特点,导致呼吸方式异常。
失语症和语言康复北京市朝阳区桓兴肿瘤医院康复科失语症所产生的语言交流障碍(Communication Disorder),影响患者与他人的人际间思想交流,故影响患者的社会生活能力和职业能力,甚至影响身心健康.言语障碍既危害大又常见,是老年人,尤其是脑血管病患者的重要致残原因之一。
国内新近报道,脑血管病人中约有70~75%出现语言障碍,故言语矫治具有十分重要的意义.一.失语症(一)概念失语症(失语Aphasia)是由于脑损害引起的语言能力丧失或受损(二)症状1.自发谈话说话费力找词困难错语流利型和非流利型失语口语表1 汉语失语症口语的流利性特点口语特征1分2分3分语量语调发音短语长短用力程度强迫言语用词语法错语<50字/分不正常构音困难短(1-2字电报式)明显费力无有实质词无无51-99字/分不完全正常不完全正常部分短语中度费力有强迫倾向实质词少有部分语法偶有>100字/分正常正常正常(每句4个字以上)不费力有缺少实质词,说话空洞有语法常有患者上述9项之和:9-13分为非流利型;14-20分为中间型;21-27分为流利型。
n2.复述模仿语言语言完成3.命名4.失认症意向运动性失用(三)分类1完全性失语亦称混合性失语。
主要临床特点是哑、或仅能发单音,或刻板的非流利型自发语言,复述.命名及口语理解不能或严重障碍。
病变部位通常在优势半球大脑中动脉分布区.预后差,维持刻板语言的口语表达,大多病例可理解日常谈话。
2Broca失语亦称运动性失语。
主要临床表现特点是完全不能讲话,或电报式非流利型自发语言,复述不能或明显困难,命名障碍,而口语理解基本正常或轻度障碍.病变部位通常在优势半球Broca区及其皮层下结构.预后视病灶大小不同。
一般较好,可以恢复到很轻的语言障碍或正常。
3Wernicke失语亦称感觉性失语。
主要临床表现特点是发音正常而有错语,答非所问的流利型自发语言,严重理解障碍及命名障碍.一般预后较差。
失语症失语症—aphasia 借助词语进行理解和表达语言符号意义的功能丧失(失语症)或言语困难。
障碍的形式取决于脑损害部位,一般分运动和感知两类,分别涉及言语生成和言语理解两方面。
言语发育障碍时也可以没有明显脑损害。
失语症是指由于神经中枢病损导致抽象信号思维障碍,而丧失口语、文字的表达和领悟能力的临床症候群,失语症不包括由于意识障碍和普通的智力减退造成的语言症状,也不包括听觉、视觉、书写、发音等感觉和运动器官损害引起的语言、阅读和书写障碍。
因先天或幼年疾病引致学习困难,造成的语言机能缺陷也不属失语症范畴。
病因病理言语功能受一侧大脑半球支配,称为优势半球。
除少数人外,绝大多数人的优势半球位于左侧大脑皮质及其连接纤维。
优势半球受损常可发生失语症。
优势半球不同特定部位受损,可出现不同类型的失语症:第三额回后部是口语的中枢,受损时丧失口语表达能力,即运动性失语症;第一颞横回后部是听语中枢,损害时出现对别人的语言不能理解,即感觉性失语症;第三额回后部是书写中枢,病变时无法用文字书写来表达,是失写症;角回为阅读中枢,受损时读不出文字的字音及不知其意义,是失读症;第一颞回与角回之间区域是物体的命名中枢,病损时讲不出所见的人物名称,是命名性失语症。
引起失语症的疾病以脑血管疾病最为多见,其次为脑部炎症、外伤、变性等。
临床表现1.运动性失语症也称表达性失语症(expressive aphasia)、口语性失语症、皮质运动性失语等。
为Broca氏区,即第三额回后部的言语运动中枢受损时引起,症状特点为患者能理解他人语言,构音器官的活动并无障碍,有的虽能发音但不能构成语言。
完全性失语时,患者完全不能用评议表达思维活动,甚至个别的字、词、音节都不能发出。
多数患者为不完全性运动性失语,患者能发出个别的语音,但不能由语音构成词句,也不能将语言排列成必要的次序,以致这些评议杂乱无章,不能令人理解。
有的患者可能保存下来最熟悉的一个单字、词或句子的片断,通常的感叹词,如“不”、“好”、“吃”、“坐”、“就是”、“再见”、等。
言语治疗学试题及答案名词解释1.语言发育迟缓是指在发育过程中的儿童其语言发育没达到同龄相应的水平,但是,这不包括由听力障碍而引起的语言发育迟缓及构音障碍等其他语言障碍类型。
2.吞咽障碍是一个总的症状名称,指口腔、咽、食管等吞咽器官发生病变时,患者的饮食出现障碍或不便而引起的症状。
p2003.构音障碍是指由于构音器官先天性或者后天性的结构异常,神经肌肉功能障碍所致的发音障碍以及虽不存在任何结构,神经,肌肉,听力障碍所致的语言障碍,主要表现可能为完全不能说法,发音异常,构音异常,音调和音量异常和吐字不清,不包括由于失语症,儿童语言发育迟缓,听力障碍所致的发音异常。
p1224.失语症是指言语获得后的障碍,是由于大脑损伤所引起的言语功能受损或丧失,常常表现为听、说、读、写、计算等各方面的障碍。
p1675.口吃是言语的流畅性障碍,俗称结巴。
表现为语言节奏性的紊乱,即口吃者因为不自主的声音重复、延长或中断,无法表达清楚自己想表达的内容。
6.气息声是指发声时声带不完全闭合导致振动周期中不断有气流逸出,发声时伴有周期性的呼吸音,将这种声质称为气息声。
严重的气息声可导致无声化,如声带麻痹早期。
7.粗糙声是指声带表面的形态改变,如声带肿胀、小结、息肉或附着黏液时,声带周期变得不规则,声带不能正常闭合或出现代偿性改变时,声音呈粗糙性的一种主观感知表现称为粗糙声。
8.痴呆是一种获得性、持续性智能损害综合症,即在无意识障碍的情况下,在认知、记忆、语言、视空间技能、情感或人格等5项精神活动领域中,有认知和记忆功能障碍等至少三项功能缺损,且影响其社会生活活动功能者。
p2379.口颜面失用是指在非语言状态下,虽然与言语产生活动有关的肌肉自发活动仍然存在,但是舌、唇、喉、咽、颊肌执行自主运动困难。
临床上言语失用不伴有口失用,但口失用常伴有言语失用。
p24010.言语失用是不能执行自主运动进行发音和言语活动。
而且这种异常是在缺乏或不能用言语肌肉的麻痹、减弱或不协调来解释的一种运动性语言障碍,或者说是一种运动程序障碍p24111.孤独症又称自闭症,是一种起病于幼年时期的广泛性神经系统发育障碍性疾病。
失语症的概述、分类和评定方法第一节、失语症的概述一、定义由于大脑受损导致的语言功能受损或丧失。
失语症是一种获得性语言障碍,表现为患者意识清楚,无精神障碍、无严重认知障碍、无感觉缺失、无口、咽喉、舌等发音器官肌肉瘫痪及共济失调,却听不懂别人及自己的讲话,说不出要表达的意思,不理解或写不出病前会读会写的字句。
二、病因失语症可由多种脑部疾病引起,常见病因有脑血管意外、脑外伤、脑部肿瘤、感染等,最常见的为脑血管病,我国的研究资料显示至少三分之一以上的脑卒中患者会产生各种言语障碍。
三、失语症语言症状由各种原因引起的失语症可表现为自发谈话、听理解、复述、命名、阅读、书写等六种基本障碍。
(一)口语表达障碍是指患者语言陈述过程困难,表现为找词、语音、词汇、句法、语法等方面的障碍。
1找词困难;2.命名障碍;3.说话费力;4.杂乱语;5.刻板语言;6.模仿语言;7. 复述障碍;8.持续症;9.语法障碍;10发音障碍;11.错语(二)听理解障碍是指患者对口语的理解能力降低或丧失,主要表现在对字词、短语、长句和文章等不同程度的理解障碍。
1. 语义辨认障碍不能理解,却能正确辨认,准确复述。
2. 语音辨认障碍不能正确辨认听到的语音。
(三)阅读障碍又称失读症,是大脑损伤导致对已经获得的文字的阅读能力丧失或受损,伴或不伴朗读障碍。
1.形、音、义失读;2.形、义失读;3.形、音失读,不能正确朗读文字,却能理解文字的意义。
(四)书写障碍书写是一种语言表达方式,除了语言本身外,还涉及视觉、听觉、运动觉、视空间功能和运动的参与。
包括失语性书写障碍、非失语性书写障碍两种。
常见表现有:1.完全书写不能;2.构字障碍;3.象形书写;4.镜像书写;5.惰性书写;6.书写过多;7.错误语法书写;8.视空间性书写障碍失语症的分类和评定方法直到今天,人们对失语症的分类仍然没有取得完全一致的意见。
由于历史上对失语症研究的学派很多,观点不尽一致,因此对于失语症的分类方法也是多种多样。
康复医学科失语症评定表ABC法操作手册一.谈话(流畅度9-27分、信息量0-6分)1.问答(录音)将病人谈话录音,对7、8项应鼓励尽量多说,录音至少5-10分钟,病人连续说时不要打断他。
一分钟内无或偶有文法结构词为无文法结构,一分钟内一半以下语句有文法结构词为少。
* 9-13,非流利;14-20,中间型;21-27流利。
2. 系列语言(录音)让患者从1数到21。
二.理解(一)是/否问题(共60分)(录音)指导为:现在我向您提一些问题,请用“是”或“不是”(对或不对)回答。
如口语表达有困难,可告诉病人用“举手”或“摆手”分别表示“是”或“不是”如需要,提问可重复一次,但需全句重复。
在病人回答时,不要以任何表示让病人觉出其回答对或不对。
如病人明确表示错了而改正,以后一回答为准。
提问后5秒未回答0分(回答错为0分且记x),5秒后回答正确给原分的一半.1—14每正确回答2分,l5—22每正确回答4分。
检查中如必要可重复说明要求。
(二)听辨认(共90分,45项,每项2分)听到名称后,让患者从一组物、画或身体部位中选出正确的。
指导为:将实物和图片不规则地放在患者面前,注意放在视野内。
对患者说:“这儿有些东西(或图),请您指一下哪个是——。
5秒内无反应记“0”,指错则在“0”分下记“x”,均为0分。
如患者指两项以上亦为0分,记“×”。
除非患者明确表示改正,以后一次为准。
身体左右指令必须左、右和部位均对才记分,否则记“0”分,并在错的字上划“x”。
(三)口头指令(共80分)从简单到有多步骤的和有语法的指令,让患者听到后执行。
指导和指令:请您照着我说的做。
必要时可重复全句一次。
第4题结束后,患者面前按序放钥匙、铅笔、纸、梳子,告诉患者“看清这些东西吗?请您照着我说的做”。
给指令前可以示范:“如我说用钥匙指铅笔就这样做”。
做给患者看,注意每项做完,按原序放好。
三.复述(共100分)(录音)包括常用词和不常用词、具体词和抽象词、短句、长句、超常复合和无意义词组。
122.《汉语失语症康复治疗专家共识》(2019)要点失语症是由于大脑损伤引起的获得性沟通交流障碍,表现为语言理解、语言表达、阅读、书写、复述、命名等能力不同程度的受损。
失语症的病因包括脑卒中、外伤、肿瘤、脑部神经退行性病变等所致的脑损伤,其中脑卒中是引发失语症的主要原因。
有报道显示50%~70%的脑卒中后患者遗留有瘫痪、失语等严重残疾,其中2l%~38%患者患有失语症,主要表现为各种语言功能的障碍,严重影响患者的情绪和生活质量。
目前有关失语症的康复治疗方法多样,可供选择的类型多,而我国尚无失语症康复治疗的相关标准或指南。
失语症概述一、失语症的常见语言障碍特点1.口语表达障碍:语言症状可能包括形成语言信息困难、错语和/或杂乱语、说话费力、找词困难或命名障碍、刻板语言、持续言语、复述困难、语法障碍、模仿语言、表达不流畅。
2.口语接收障碍:包括听理解(含接收障碍、感知障碍、词义障碍、句法障碍、特殊范畴障碍等)和听执行障碍。
二、失语症的分类1.外侧裂周失语综合征(1)Broca失语(BA)(2)Wernicke失语(WA)(3)传导性失语(CA)2.分水岭区失语综合征(1)经皮质运动性失语(TMAl(2)经皮质感觉性失语(TSA)(3)经皮质混合性失语(MTAl3.命名性失语(AA)4.完全性失语(GA)5.皮质下失语(1)丘脑性失语(TA)(2)基底节性失语(BaA)6.纯词聋7.纯词哑8.失读症9.失写症三、失语症的预后及影响因素许多因素会影响失语症的自发恢复,这些因素包括:脑卒中或其它神经源性病因的病程;病灶周围未受损组织数量;健康状况、血糖调节、休息、锻炼或健身、营养、水电解质平衡;康复欲望(内在和外在);发病前认知水平;发病前学习技能;教育背景、职业背景;优秀临床失语症学家的介入;在合适时间言语语言治疗介入的质量、类型和频率;接受整体康复计划;社会心理支持;对自身缺陷的认识;独立使用代偿性和自我提示策略;独立生活或者独立生活背景;接受特定的认知语言任务的可激励性;愿意参与并练习代偿性策略;执行能力、记忆、注意力、判断能力、应对技能;自尊;职业和业余爱好目标;挫败感的忍受能力;愤怒管理策略。
Taiwan Journal of LinguisticsV ol. 3.1, 101-132, 2005BREATH-GROUP THEORY VS. DECLINATION THEORY:EVIDENCE FROM CHINESE APHASICS∗Wen-Hui SahABSTRACTThis study explores in what way the breath-group theory and the declination theory manifest themselves in Chinese aphasic speech and detects the extent to which aphasics exert control over sentential F0 c ontours concerning different sentence lengths and tones. Four Broca’s aphasics, four Wernicke’s aphasics and four age-matched normal controls are tested. The results indicate that aphasic subjects have impairments in processing these sentential F0patterns. Yet, neither the declination nor the breath-group pattern can serve as the criterion in differentiating these two aphasic populations. The breath-group pattern is the better option than the declination pattern in delineating sentential F0 c ontour in Mandarin Chinese speech, from which we note that the predictive power of the declination theory deserves reconsideration.1. INTRODUCTIONLieberman (1967) associates speech with respiration by stating that speech is planned in terms of the expiratory airflow from the lungs. He regards the “breath-group” as the basic unit for intonation and points out its chief function in segmenting speech signals into chunks. He also ∗I am grateful to the anonymous reviewers for their valuable comments, which led to improvement of this paper. All gaps, mistakes and misunderstandings are my own responsibility.101Sah, Wen-Hui102makes a distinction between the unmarked breath-group pattern and the marked one.1 At the end of each unmarked breath-group, the fundamental frequency (hereafter as F 0) will fall along with the decreasing pulmonary air pressure if the laryngeal tension is not deliberately increased.2 According to Lieberman, the archetypal normal, or unmarked, breath-group is characterized by the terminal F 0 fall rather than the prosodic pattern before the terminal point. As he states (p. 26):It is a universal of human speech that, except for certain predictable cases, the fundamental frequency of phonation and the acoustic amplitude fall at the end of a sentence.Lieberman and Blumstein (1988) state that most unemphatic, declarative sentences are produced by means of the unmarked pattern for its minimal muscular effort. In contrast, the “marked” pattern will be formed if the tension of the laryngeal muscles is increased at the end of the sentence with the pulmonary air pressure decreasing as usual. This pattern is the phonetic output of the normal yes-no question and that of the non-terminal breath-group of a long declarative sentence.3Several later studies take the position different from that of the breath-group theory (Maeda, 1976; Liberman and Pierrehumbert, 1984; Sorensen and Cooper, 1980; Thorsen, 1986). These studies propose that the declination pattern characterized by linear decrease in pitch throughout the course of a declarative utterance is a near-universal tendency of intonation. In an earlier perceptual study by Cohen and 'T Hart (1967), a “declination line” is presented to characterize Dutch intonation. Similarly, Maeda (1976) uses the “trapezoidal shape” of localized movements superposing on the gradual falling “baseline” to describe the intonation of English declarative sentences.4 He proposes1 The notations –breath-group and +breath-group are used to represent the unmarked pattern and the marked one, respectively.2 The studies on language development and infants' initial vocalizations lead Lieberman to conclude that the terminal F 0 fall of the breath-group is innately determined and that children may acquire the idiosyncratic pattern of the breath-group of their mother tongue during the first year of life (Lieberman, 1967).3 Due to physiological constraints, a longer sentence is often divided into more than one breath-group. The non-terminal breath-group uses non-falling F 0 contour of the marked pattern to signal continuation.4 The baseline refers to the line connecting all the F 0 valleys of a sentence.Breath-Group Theory vs. Declination Theory 103five attributes and several rules to represent F 0 contours and conducts perceptual experiments to test the validity of the schematized F 0 patterns.5 According to him, the magnitude of F 0 falling as well as the F 0 value at the terminal point of the breath-group is roughly constant for an individual speaker. Maeda notes that the terminal F 0 fall is primarily determined by the shortening of the vocal-fold length subsequent to the decrease in lung volume, whereas the subglottal air pressure is only partially responsible for the F 0 fall. In contrast to Maeda's baseline, the Pierrehumbert and Liberman version of the declination theory proposes the topline (Pierrehumbert, 1977, 1979, Liberman and Pierrehumbert, 1984).6 They claim that both topline and baseline display the declination effect, and that the former declines at a more rapid rate than the latter. Sorensen and Cooper (1980) assert that the topline is the better choice in capturing the essence of F 0 declination. In a later study, they formulate the topline rule and test the validity of it in predicting declination (Cooper and Sorensen, 1981). They claim that the magnitude of F 0 fall is proportional to the length of the entire sentence and that the higher F 0 value for the first peak accompanies the longer sentence (i.e., the P1 effect).7 Moreover, they use the floor effect to explain the small deviation of the terminal F 0 value. Similarly, Thorsen (1986) observes the positive correlation between sentence length and the magnitude of F 0 f all. Yet, he questions the validity of the floor effect.While the declination theory strictly defines a gradual fall in F 0 t hroughout a declarative sentence, the breath-group theory specifies only the terminal F 0 f all without characterizing the exact prosodic pattern before the terminal fall. As Tseng (1990) points out, the declination theory can be regarded as a special case of the breath-group theory. In contrast to the near-universal claim of the former, the latter offers no5 These five attributes are baseline , rise , lowering , peak , and rise on the plateau . 6The topline refers to the line connecting all F 0 p eaks of a sentence. 7 P1 stands for the first F 0 peak of a sentence. The P1 effect refers to the higher F 0 values of the first peak in the longer sentence compared with that in the shorter sentence. For instance, comparing the P1 F 0 v alue of two sentences, we find this effect for the normal speaker, with P1 F 0 v alue several hertz greater in the longer sentence than in the shorter sentence. The differences in P1 F 0 values in the long versus short utterances demonstrate normal speakers' look-ahead mechanism which programs the P1 F 0 value by taking into consideration the overall length of the upcoming utterance (Cooper and Paccia-Cooper, 1980, Cooper and Sorensen, 1981).Sah, Wen-Hui104claims of universality. Thus, the breath-group theory is less powerful in making prediction, yet it can more flexibly characterize the possible intonation contours for simple declarative sentences.8To test if the above-mentioned theories properly represent the intonation pattern for simple declarative Mandarin sentences, Tseng (1990) analyzes the overall intonation contours of spontaneous speech of two female Mandarin speakers. According to her, the declination pattern only captures the essence of a very small portion (20 %) of the data, whereas 74 % of the data can be characterized by the breath-group pattern. Accordingly, the predictability of the declination theory is questioned. In consonance with Tseng, Liu (1990) claims that the breath-group pattern can more properly describe the intonation contours of read speech than the declination pattern.9 Moreover, 86% of her data exhibit the lowest valley F 0 value at the final target-word, whereas merely 69 % of the data demonstrate the lowest peak F 0 value at the final target-word. Thus, Liu suggests that the primary feature of the breath-group in Mandarin Chinese speech is the lowering of the valley F 0 value of the terminal word and asserts that the baseline rather than the topline can better characterize the declination pattern in Mandarin speech. Liu's subject shows no correlation between the magnitude of the F 0 lowering and sentence length, but exhibits negative correlation between the magnitude of F 0 lowering and the complexity of the sentence structure.10 Maeda (1976) uses the floor effect to explain that the sentence-final valley F 0 v alue is a relatively invariant characteristic of a speaker’s voice. Similarly, Liberman and Pierrehumbert (1984) state that the sentence-final low point F 0 values in both of their experiments are essentially the same. They note that the final low value is rather constant for each individual speaker. However, in Liu's research, the speech output of the male Mandarin speaker does not exhibit the floor effect,8According to Umeda (1981, 1982), the declination pattern has a discourse function. A speaker may use the declination intonation pattern to introduce a new topic for a discourse. However, during the course of the discourse, the archetypal breath-group pattern is used. The difference in discourse functions carried by these two intonation patterns is another interesting topic. Yet, it is beyond the scope of the present study. 9 The term “read speech” is used by Lieberman et al. (1985) to refer to the prepared speech or the reading mode of speech. 10 The negative correlation: The simpler the sentence structure is, the greater magnitude at which the F 0 falls.Breath-Group Theory vs. Declination Theory 105since both the peak and valley F 0 values of the terminal word vary across a large range.Within the last few decades, the intact and disordered elements of prosody have become increasingly useful media for making inferences about language representation and speech planning (Danly and Shapiro, 1982; Shapiro and Nagel, 1995; Blonder et al., 1995; Baum et al., 1997; Gandour and Dardarananda, 1984; Gandour and Petty, 1989; Gandour et al.; 1994, Schirmer et al.; 2001, Kimelman, 1999; Vijayan, 1998) he presence or absence of F 0 declination in aphasics allows us to assess patients' ability in programming sentential F 0 patterns. From three experiments using Broca's and normal subjects, Danly and Shapiro (1982) detect that patients' F 0 declination is present in short and simple sentences but does not occur over longer domains and that patients do not exhibit the P1 effect. They suggest that the declination might be attenuated by the extreme length of time that patients require to produce the sentences. Furthermore, they present a significant correlation between the declination slope and the degree of language disorder in Broca's aphasics; that is, the presence or absence of the downdrift reflects the severity of aphasia. On the other hand, Cooper, Danly and Hamby (1979) detect that Wernicke's speakers exhibit F 0 declination, though the obtained slope does not adhere to the topline rule precisely. There is no interaction between literal paraphasia and F 0 declination, which indicates that declination planning is independent of proper phoneme selection. In a later study, Danly, Cooper and Shapiro (1983) demonstrate that F 0 declination of Wernicke's aphasics is comparable to that of normal controls (except in the severest cases), and shows no interaction with verbal paraphasia or degree of impairment. According to them, Wernicke's aphasics are able to take into consideration the sentence length and declination slope to produce an initially higher F 0 value for longer sentences than for shorter ones.In an earlier study, Sah (2004) explore the sentence-final peak-to-valley (hereafter as P-V) F 0 fall and the P1 effect in Chinese aphasic speech. Previous studies on English aphasics claim that the sentence-final P-V F 0 f all is the largest fall in magnitude. Surprisingly, Sah’s work shows that the terminal P-V F 0 fall is not the largest F 0 f all for Mandarin Chinese speakers, normal or aphasic. The discrepancy between Chinese and English speakers concerning the largest terminal P-V F 0 fall is attributed to the difference in sentence lengths used in different studies. The analysis regarding the P1 effect aims to examineSah, Wen-Hui106whether the aphasic subjects can encode sentence length by appropriately planning the initial F 0 value. The results indicate that Broca's aphasics are impaired in programming this prosodic feature. In contrast, Wernicke’s patients remain intact in this ability, which means that they are able to combine the factors of sentence length and F 0 contour in order to produce higher values of P1 for longer sentences. The issue closely relates to the sentence-final P-V F 0 fall and the P1 effect is the applicability of the breath-group theory and that of the declination theory.Previous studies have explored the breath-group and the declination patterns for simple declarative Mandarin sentences from normal speakers. The present work differs from earlier investigations in including not only normal but also aphasic speakers in our subject pool. Despite widespread interest in the prosodic disturbances in aphasic patients, we lack information on how the breath-group and the declination patterns manifest themselves in aphasic speech. To fill a gap that currently exists in this respect, we aim to examine whether these F 0 patterns properly represent the intonation contours for simple declarative sentences from Mandarin Chinese speakers, normal and/or aphasic.2. METHODSThe acoustic methodology reveals things about aphasics’ internal code more directly than perceptual judgements (Cooper and Paccia-Cooper, 1980; Ryalls, 1982; Cruttenden, 1986; Baum and Boyczuk, 1999); therefore, the present study adopts the acoustic method to obtain a more objective assessment of the planning of sentential F 0 contours in Chinese aphasic speech.We use the breath-group and the declination patterns as the criteria to examine aphasic patients’ F 0 c ontours for simple declarative sentences.11 Two research questions will be addressed:11 Since the previous studies mentioned above and the present work all focus on simple declarative sentences, only the unmarked breath-group intonation pattern is considered and explored in the following discussion. The marked pattern is beyond the scope of the present investigation.Breath-Group Theory vs. Declination Theory107(1) How do the breath-group and the declination patterns manifestthemselves in Chinese aphasic speech?(2) To what extent do aphasics exert control over sentential F 0 contours concerning different sentence lengths and tones?2.1 SubjectsEight aphasics and four age-matched normal controls serve as subjects in the experiment. All subjects are male and predominantly right-handed. The patient group comprises four Broca’s and four Wernicke’s aphasics; all of them suffer unilateral left-hemisphere damage subsequent to cerebral vascular disease or brain trauma, and have neither auditory nor visual disturbance. The diagnosis of aphasia is based upon a Chinese adaptation of the BDAE; the sites of lesions are determined by neurologists and corroborated by Computerized Tomography (CT) scan. The aphasic subjects are tested at least three months post onset. The normal controls roughly match in age and educational level to the aphasic subjects. All subjects are native speakers of Mandarin Chinese. Their personal background and medical data are illustrated in Table 1 (for Tables, see Appendix A).2.2 StimuliFour groups, each with eight sentences, are constructed to test the subjects. Each group comprises four pairs; the target words in each pair represent one distinct Mandarin tone. Sentences range in length from six to fourteen syllables (Appendix B). The target words are the second syllable of disyllabic words which are all content words of high frequency.12 One sample set appears below with the target words in parentheses. Filler sentences that match with the real target sentences in terms of length, phonetic environment and syntactic structure are used as the first and the last sentences of each recording session to minimize initiation and completion effects.Ala12 As previous studies demonstrate, there are more phonological errors on content words than on function words and the speech production of Broca’s aphasics is predominantly full of content words and often omits function ones (Blumstein, 1973).Sah, Wen-Hui108 Bla )ClaDla2.3 ProceduresThe test sentences are randomized across the subjects. An interval of approximately three seconds exists between the presentation of each sentence. The subjects were asked to read the test materials as naturally as possible and not to place contrastive or emphatic stress on any word. Before recording, the sentence was presented to the subject who was asked to read it aloud to ensure that he recognized the words and to practice it several times until at least one clearly articulated version of the completed sentence was produced.13The whole process of performing the task was audio-taped.2.4 Data measurement and analysisFor each target-word, we use Visi-Pitch to measure the F0values of the tone-bearing unit at the peak and the valley. Two sentential F0 c ontour patterns are examined: the breath-group and the declination patterns. For ease of comparison with the results from previous studies, we set up four categories based on Liu's definitions (1990) for these F0patterns, as stated below.Category I: If the peak F0value of the terminal word is the lowest compared to the peak value(s) of the preceding target-word(s), the sentence is called the breath-group sentence.Category II: If the valley F0value of the terminal word is the lowest compared to the valley value(s) of the precedingtarget-word(s), the sentence is classified as the breath-groupsentence.Category III: If the line connecting the F0peaks of all target13The Broca’s aphasic HT could not read sentences D2b and D4b on his own, so he was asked to repeat after the experimenter. He did not present any difficulty in repeating. Among the data collected, only these two are the repeated sentences. Owing to the scarcity of the repeated sentences, the possible practice effects of the repeated sentences are not considered here.Breath-Group Theory vs. Declination Theory109words, i.e., the topline , decreases throughout the sentence, thesentence belongs to the declination group.Category IV : If the line connecting the F 0 valleys of all target words, i.e., the baseline , decreases from the beginning to theend of the sentence, the sentence is considered to be thedeclination sentence.The F 0 c ontour patterns serve as dependent variables, while independent variables include both linguistic and non-linguistic factors: subject group (normal vs. aphasic speakers), sentence length (sentences of various lengths) and tone (four tones of Mandarin Chinese). Because the effects investigated in this study are analyzed in terms of frequency of occurrence, viz., on an all-or-none, discrete scale, we use overall and individual log-linear tests and the supplementary proportional z-test to assess the data. For the log-linear test, the probability (p) value has to be smaller than 0.05 to reach the significant level, while the z-score has to be larger than 1.96 to reach significance.3. RESULTS AND DISCUSSIONLieberman (1967) suggests that the breath-group pattern can properly represent the intonation contour for simple declarative sentences, while others believe that the declination pattern is a better candidate. In terms of the above-mentioned four categories, we first present the frequency distribution of sentences that can be characterized by the breath-group or the declination pattern, discuss subject group, sentence length and tone main effect on the distribution of these two intonation patterns (Section3.1) and then assess which pattern most properly delineates the intonation contours for simple declarative Mandarin sentences (Section3.2).3.1Frequency distribution of breath-group and declination patternsThere are 201 of the total 360 sentences classified into Category I (55.83 %). On the other hand, 217 of total utterances fall into Category II (60.28 %), with the frequency percentage larger than that of the former group. Tables 2 through 9 display the frequency distributions of Category I and II for individual independent variables and forSah, Wen-Hui110cross-sections of all these variables.For sentences of Category I, we note that occurrence rate for normals (44.78 %) is obviously larger than that for Broca's (26.87 %) and for Wernicke's (28.36 %) subjects. The frequency difference between two-target- word sentences and sentences of other lengths also deserves attention. The results of the individual test of the log-linear analysis demonstrate significantly larger occurrence rate for two-target-word than for five-target-word sentences (χ24 = 10.44, p = .001), but fail to demonstrate significant differences among subject groups, among tones or significant interactions among variables. By means of supplementary proportional z-test, we find significant differences between normals and Broca's aphasics (z = 3.73) and between normals and Wernicke's subjects (z = 3.30), but nonsignificant difference between Wernicke's and Broca's aphasics (z = .33). As for the sentence length, there are significant differences between two- and three- (z = 2.57), between two- and four- (z = 3.61), and between two- and five-target-word (z = 3.99) sentences.Regarding sentences of Category II, the occurrence rate for normals (45.62 %) is obviously larger than that for Broca's (26.27 %) and Wernicke's (28.11 %) aphasics. The overall test of the log-linear analysis also exhibits significant subject main effect (χ22 = 13.60, p = .001). Nevertheless, due to the insensitivity of the test to the limited data, the individual test fails to further display significant frequency differences among subject groups, among sentence-lengths, or among tones. As in the above case, the z-scores present significant differences between normal and Broca's subjects (z= 4.2) and between normal and Wernicke's subjects (z = 3.78), but nonsignificant difference between Broca's and Wernicke's subjects (z = .43). The significant frequency differences are also established between two- and four- (z = 3.17) and between two- and five-target-word (z =2.32) sentences.The criteria for Category III and IV characterize the declination patterns. There are 133 of the total 360 utterances (36.94 %) exhibiting the topline effect (Category III), whereas 143 of the total utterances (39.72 %) demonstrate the baseline effect (Category IV). Tables 10 through 17 demonstrate the frequency distribution of Categories III and IV for individual major variables and for cross-sections of all three variables.With respect to Category III, normals (51.13 %) exhibit larger frequency of the topline effect than Broca's (21.05 %) and Wernicke's (27.82 %) aphasics; the two-target-word sentences (52.63 %) revealBreath-Group Theory vs. Declination Theory111obviously larger frequency than sentences of other lengths (Table 10).By means of the overall test of the log-linear analysis, significant subjectmain effect (χ22= 9.01, p =.011) and sentence length main effect (χ23= 23.11, p =.000) are obtained, whereas neither tone main effect (p =.860)nor any interaction among variables is revealed. Due to its insensitivityto the limited data, the individual log-linear test fails to reveal significantdifferences between Broca's and normal subjects (p = .232), betweenWernicke's and normal subjects (p = .325), or among various sentencelengths. Again, the supplementary proportional z-test is used as analternative to assess the data. The resulting z-scores reveal significantfrequency differences between normal and Broca's subjects (z=5.12),between normal and Wernicke's subjects (z = 3.90), and between two-and three- (z =5.21), between two- and four- (z = 7.17) and between two-and five-target-word (z = 7.87) sentences, which confirm the tendencyshown above in percentages.As illustrated in Table 14, normals (50.35 %) demonstrate largerfrequency of the baseline effect than Broca's (24.48 %) and Wernicke's(25.17 %) aphasics; the frequency of two-target-word (48.25%)sentences is conspicuously larger than that of other sentence lengths.The results of the overall test of the log-linear analysis present subjectmain effect (χ22 = 10.77, p =.005) and sentence length main effect (χ23= 26.54, p = .000), while neither tone main effect (p= .428) nor anysignificant interaction among variables is displayed. The individual testfurther indicates that the frequency of the baseline effect fortwo-target-word sentences is significantly larger than that forfive-target-word sentences (χ24 = 23.96, p = .000); however, this test fails to exhibit significant frequency differences between Broca's and normalsubjects (p = .255), between Wernicke's and normal subjects (p= .301)and among other length-pairs. On the other hand, the supplementaryproportional z-test reveals significant frequency differences betweennormal and Broca's subjects (z = 4.5) and between normal andWernicke's subjects (z = 4.39), but nonsignificant difference betweenWernicke's and Broca's subjects (z = .13). According to z-scores, theoccurrence rate of the baseline effect for the two-target-word sentences issignificantly larger than that for three- (z = 3.57), for four- (z = 6.71),and for five-target-word(z = 8.86) sentences.As indicated in statistics and larger percentage of frequencies inpreceding paragraphs, normals exhibit more pronounced than aphasicSah, Wen-Hui112speakers the tendency of employing declination and breath-grouppatterns as the general feature in programming intonation contours forsimple declarative sentences of Mandarin Chinese. On the other hand,aphasic speakers are impaired in this regard as reflected by thesignificant differences between normals and aphasics, both inpercentages and in z- scores. Nevertheless, the frequency differencesbetween Broca's and Wernicke's subjects concerning both patterns do notreach significance, which implies that neither the declination nor thebreath-group pattern can serve as a criterion in differentiating these twoaphasic populations.Clinically, Broca’s and Wernicke’s speakers are contrasted in termsof their control of melodic line over an entire sentence. Broca’s aphasicsare characterized by dysprosody, while Wernicke’s patients areconsidered to have normal prosody. Yet, our aphasic groups fail todisplay significant differences in prosodic control over the breath-groupor the declination pattern, which leads us to question the validity ofdifferentiating Broca’s from Wernicke’s aphasia in terms of “prosody.”The discrepancy between clinical classification and our findings may beattributed to the heterogeneity of prosody. It is also the task of thepresent work to show how acoustic study might clarify the notion aboutprosody in clinical application.The statistics for all four categories show that tones fail to exertsignificant influence on the frequency distribution of both intonationpatterns. Regarding sentence lengths, there is significant distributionaldifference in these F 0 contours between sentences of two-target-words and those of other lengths. Inspection of data shows that the length effectmainly comes from the aphasic group, which reflects the negativecorrelation between F 0 programming and sentence length. The negative correlation between the increase in the sentence length and the decreasein the occurrence rate of both intonation patterns implies that it is moredifficult for the aphasics to produce these F 0 contours in longer sentences (Tables 3, 7, 11, and 15).The length effect shown above is consonant with the earlier findingby Danly and Shapiro (1982), which states that Broca’s patients’ F 0 declination is present in short and simple sentences but absent in longerones. Previous studies on English aphasics also claim that Wernicke’saphasics exhibit F 0 declination comparable to normal speakers (Cooper, Danly and Hamby, 1979; Danly, Cooper and Shapiro, 1983).Surprisingly, our results show that Chinese Wernicke’s aphasics are。