ABSTRACT
Aphasia has traditionally been viewed as a loss or impairment of language. However,
evidence is presented suggesting that language mechanisms are fundamentally preserved
and that aphasic language behaviors are instead due to impairments of cognitive processes
supporting their construction. These processes may be understood as a linguistically
specialized attentional system that is vulnerable to competition from other processing
domains. We present two models of attention that focus on competition for central
processing and discuss findings from dual-task studies of normal and aphasic performance.
First, competing language and nonlanguage tasks appear to share limited-capacity,
parallel processing resources. Second, aphasic individuals demonstrate slowed central
processing that could be due to a reduction in processing capacity or ability to allocate
that capacity. Third, the attention models discussed bear a coherent relationship
to current models of language processing. Clinical implications of a cognitive processing
account of aphasia are also considered.
KEYWORDS
Aphasia - attention - psychological refractory period
REFERENCES
1 Schuell H, Jenkins J J, Jimenez-Pabon E. Aphasia in Adults: Diagnosis, Prognosis,
and Treatment. New York, NY; Harper & Row 1964
2 Darley F L. Aphasia. Philadelphia, PA; WB Saunders 1982
3
McNeil M R, Pratt S R.
A standard definition of aphasia: toward a general theory of aphasia.
Aphasiology.
2001;
15
901-911
4 Benson D F. Aphasia, Alexia, and Agraphia. New York, NY; Churchill Livingstone 1979
5 Saffran E M, Schwartz M F, Marin O SM.
Evidence from aphasia: isolating the components of a production model . In: Butterworth B Language Production. London, United Kingdom; Academic Press 1980:
221-240
6
Martin N, Dell G S, Saffran E M, Schwartz M F.
Origins of paraphasias in deep dysphasia: testing the consequences of a decay impairment
to an interactive spreading activation model of lexical retrieval.
Brain Lang.
1994;
47
609-660
7 Craven RR, Hirnle CJ Fundamentals of Nursing: Human Health and Function. 6th ed. Philadelphia,
PA; Lippincott Williams and Wilkins 2009
8
McNeil M R, Hageman C F, Matthews C T.
Auditory processing deficits in aphasia evidenced on the Revised Token Test: incidence
and prediction of across subtest and across item within subtest patterns.
Aphasiology.
2005;
19
179-198
9
Hageman C F, Folkstad A.
Performance of aphasic listeners on an expanded revised token test subtest presented
verbally and nonverbally.
Clinical Aphasiology.
1986;
16
226-233
10
Hageman C F, McNeil M R, Rucci-Zimmer S, Cariski D M.
The reliability of patterns of auditory processing deficits: evidence from the Revised
Token Test.
Clinical Aphasiology.
1982;
12
230-234
11
Peach R K, Rubin S S, Newhoff M.
A topographic event-related potential analysis of the attention deficit for auditory
processing in aphasia.
Clinical Aphasiology.
1994;
24
81-96
12 McNeil M R.
Aphasia in the adult . In: Lass NJ, McReynolds LV, Northern J, Yoder DE Handbook of Speech-Language Pathology
and Audiology. Toronto, Canada; BC Decker 1988: 738-786
13
Milberg W, Blumstein S, Dworetzky B.
Phonological processing and lexical access in aphasia.
Brain Lang.
1988;
34
279-293
14
Prather P A, Zurif E, Love T, Brownell H.
Speed of lexical activation in nonfluent Broca's aphasia and fluent Wernicke's aphasia.
Brain Lang.
1997;
59
391-411
15
Martin N, Fink R, Laine M, Ayala J.
Immediate and short-term effects of contextual priming on word retrieval in aphasia.
Aphasiology.
2004;
18
867-898
16
Haarmann H J, Kolk H HJ.
Syntactic priming in Broca's aphasics: evidence for slow activation.
Aphasiology.
1991;
5
247-263
17
Baum S R.
Phonological, semantic, and mediated priming in aphasia.
Brain Lang.
1997;
60
347-359
18
Wilshire C E, Saffran E M.
Contrasting effects of phonological priming in aphasic word production.
Cognition.
2005;
95
31-71
19
Benton A L, Smith K C, Lang M.
Stimulus characteristics and object naming in aphasic patients.
J Commun Disord.
1972;
5
19-24
20
Martin P I, Naeser M A, Ho M et al..
Overt naming fMRI pre- and post-TMS: two nonfluent aphasia patients, with and without
improved naming post-TMS.
Brain Lang.
2007;
103
248-249
21
Naeser M A, Martin P I, Nicholas M et al..
Improved picture naming in chronic aphasia after TMS to part of right Broca's area:
an open-protocol study.
Brain Lang.
2005;
93
95-105
22
Lomas J, Kertesz A.
Patterns of spontaneous recovery in aphasic groups: a study of adult stroke patients.
Brain Lang.
1978;
5
388-401
23
Hillis A E, Wityk R J, Barker P B et al..
Subcortical aphasia and neglect in acute stroke: the role of cortical hypoperfusion.
Brain.
2002;
125
1094-1104
24
Hillis A E, Wityk R J, Tuffiash E et al..
Hypoperfusion of Wernicke's area predicts severity of semantic deficit in acute stroke.
Ann Neurol.
2001;
50
561-566
25
Hamilton N G, Matthews T.
Aphasia: the sole manifestation of focal status epilepticus.
Neurology.
1979;
29
745-748
26
Linebaugh C W, Coakley A S, Arrigan A F, Racy A.
Epileptogenic aphasia.
Clinical Aphasiology.
1979;
9
70-78
27
Lecours A R, Joanette Y.
Linguistic and other psychological aspects of paroxysmal aphasia.
Brain Lang.
1980;
10
1-23
28
Kilborn K.
Selective impairment of grammatical morphology due to induced stress in normal listeners:
implications for aphasia.
Brain Lang.
1991;
41
275-288
29
Dick F, Bates E, Ferstl E C.
Spectral and temporal degradation of speech as a simulation of morphosyntactic deficits
in English and German.
Brain Lang.
2003;
85
535-542
30
Miyake A, Carpenter P A, Just M A.
A capacity approach to syntactic comprehension disorders: making normal adults perform
like aphasic patients.
Cogn Neuropsychol.
1994;
11
671-717
31
Blackwell A, Bates E.
Inducing agrammatic profiles in normals: evidence for the selective vulnerability
of morphology under cognitive resource limitation.
J Cogn Neurosci.
1995;
7
228-257
32
Coppens P, Frisinger D.
Category-specific naming effect in non-brain-damaged individuals.
Brain Lang.
2005;
94
61-71
33
Hodgson C, Lambon Ralph M A.
Mimicking aphasic semantic errors in normal speech production: evidence from a novel
experimental paradigm.
Brain Lang.
2008;
104
89-101
34
Silkes J, McNeil M R, Drton M.
Simulation of aphasic naming performance in non-brain-damaged adults.
J Speech Lang Hear Res.
2004;
47
610-623
35
Buckingham H W.
Freud's continuity thesis.
Brain Lang.
1999;
69
76-92
36
McNeil M R.
Aphasia: neurological considerations.
Top Lang Disord.
1983;
3
1-19
37 Kreindler A, Fradis A. Performances in Aphasia: A Neurodynamical Diagnostic and
Psychological Study. Paris, France; Gauthier-Villars 1968
38 Crisman L G. Response Variability in Naming Behavior of Aphasic Patients. Unpublished
master's thesis Pittsburgh, PA; University of Pittsburgh 1971
39
Howard D, Patterson K, Franklin S, Morton J, Orchard-Lisle V.
Variability and consistency in naming by aphasic patients.
Adv Neurol.
1984;
42
263-276
40
Freed D B, Marshall R C, Chulantseff E A.
Picture naming variability: a methodological consideration of inconsistent naming
responses in fluent and nonfluent aphasia.
Clin Aphasiol.
1996;
26
193-205
41
Caplan D, Waters G, Dede G, Michaud J, Reddy A.
A study of syntactic processing in aphasia. I: Behavioral (psycholinguistic) aspects.
Brain Lang.
2007;
101
103-150
42 Head H. Aphasia and Kindred Disorders of Speech. Cambridge, United Kingdom; Cambridge
University Press 1926
43
Kolk H.
Variability is the hallmark of aphasic behaviour: grammatical behaviour is no exception.
Brain Lang.
2007;
101
99-102
44
McNeil M R, Odell K, Tseng C H.
Toward the integration of resource allocation into a general theory of aphasia.
Clin Aphasiol.
1991;
21
21-39
45 Baddeley A D, Hitch G J.
Working memory . In: Bower GH The Psychology of Learning and Motivation: Advances in Research and
Theory. New York, NY; Academic Press 1974: 47-89
46
Caplan D, Waters G S.
Verbal working memory and sentence comprehension.
Behav Brain Sci.
1999;
22
77-126
47 Cowan N. Working Memory Capacity. New York, NY; Psychological Press 2005
48 Engle R W, Kane M J.
Executive attention, working memory capacity, and a two-factor theory of cognitive
control . In: Ross B The Psychology of Learning and Motivation. New York, NY; Elsevier 2004:
145-199
49
Just M, Carpenter P.
A capacity theory of comprehension: individual differences in working memory.
Psychol Rev.
1992;
99
122-149
50 Kane M J, Conway A RA, Hambrick D Z, Engle R W.
Variation in working memory capacity as variation in executive attention and control . In: Conway ARA, Jarrold C, Kane MJ, Miyake A, Towse JN Variation in Working Memory. New
York, NY; Oxford University Press 2007: 21-48
51
Kane M J, Poole B J, Tuholski S W.
Working memory capacity and the top-down control of visual search: exploring the boundaries
of “executive attention”.
J Exp Psychol Learn Mem Cogn.
2006;
32
749-777
52 Kahneman D. Attention and Effort. Englewood Cliffs, NJ; Prentice-Hall 1973
53
Navon D.
Resources—a theoretical soup stone?.
Psychol Rev.
1984;
91
216-234
54 Pashler H. The Psychology of Attention. Cambridge, MA; MIT Press 1998
55
Arvedson J C, McNeil M R.
Accuracy and response times for semantic judgments and lexical decisions with left
and right hemisphere lesions.
ClinAphasiol.
1987;
17
188-200
56 Odell K H, McNeil M R. Processing relationships between the comprehension of syntax
and lexical-semantics in adult aphasia. Presented at: the Academy of Aphasia November
1–3, 1998 Santa Fe, NM;
57
Tseng C H, McNeil M R, Milenkovic P.
An investigation of attention allocation deficits in aphasia.
Brain Lang.
1993;
45
276-296
58
Slansky B L, McNeil M R.
Resource allocation in auditory processing of emphatically stressed stimuli in aphasia.
Aphasiology.
1997;
11
461-472
59
LaPointe L L, Erickson R J.
Auditory vigilance during divided task attention in aphasic individuals.
Aphasiology.
1991;
5
511-520
60
Herath P, Klingberg T, Young J, Amunts K, Roland P.
Neural correlates of dual task interference can be dissociated from those of divided
attention: an fMRI study.
Cereb Cortex.
2001;
11
796-805
61
Pashler H.
Processing stages in overlapping tasks: evidence for a central bottleneck.
J Exp Psychol Human Percept Perform.
1984;
10
358-377
62
Pashler H.
Dual-task interference in simple tasks: data and theory.
Psychol Bull.
1994;
116
220-244
63
Navon D, Miller J.
Queuing or sharing? A critical evaluation of the single-bottleneck notion.
Cognit Psychol.
2002;
44
193-251
64
Tombu M, Jolicoeur P.
A central capacity sharing model of dual-task performance.
J Exp Psychol Human Percept Perform.
2003;
29
3-18
65
Tombu M, Jolicoeur P.
Does size rescaling require central attention?.
Can J Exp Psychol.
2002;
56
10-17
66
Reynolds M, Besner D.
Reading aloud is not automatic: processing capacity is required to generate a phonological
code from print.
J Exp Psychol Human Percept Perform.
2006;
32
1303-1323
67
De Jong R.
Multiple bottlenecks in overlapping task performance.
J Exp Psychol Human Percept Perform.
1993;
19
965-980
68
Pashler H, Johnston J C.
Chronometric evidence for central postponement temporally overlapping tasks.
Q J Exp Psychol.
1989;
41A
19-45
69
Pashler H.
Dissociations and dependencies between speed and accuracy: evidence of a two component
theory of divided attention in simple tasks.
Cognit Psychol.
1989;
21
469-514
70
Johnston J C, McCann R S, Remington R W.
Chronometric evidence for two types of attention.
Psychol Sci.
1995;
6
365-369
71
Fagot C, Pashler H.
Making two responses to a single object: implications for the central attentional
bottleneck.
J Exp Psychol Human Percept Perform.
1992;
18
1058-1079
72
Carrier L M, Pashler H.
Attentional limits in memory retrieval.
J Exp Psychol Learn Mem Cogn.
1995;
21
1339-1348
73
McCann R S, Johnston J C.
Locus of the single-channel bottleneck in dual-task interference.
J Exp Psychol Human Percept Perform.
1992;
18
471-484
74
Pashler H.
Shifting visual attention and selecting motor responses: distinct attentional mechanisms.
J Exp Psychol Human Percept Perform.
1991;
17
1023-1040
75
Smith M C.
The effect of varying information on the psychological refractory period.
Acta Psychol (Amst).
1969;
30
220-231
76
Tombu M, Jolicoeur P.
All-or-none bottleneck versus capacity sharing accounts of the psychological refractory
period phenomenon.
Psychol Res.
2002;
66
274-286
77 Hula W D, McNeil M R. Lexical frequency in dual-task picture naming: evidence for
resource sharing. Presented at: the annual convention of the American Speech-Language
Hearing Association November 15–17, 2007 Boston, MA;
78
Ferreira V S, Pashler H.
Central bottleneck influences on the processing stages of word production.
J Exp Psychol Learn Mem Cogn.
2002;
28
1187-1199
79
Van Selst M, Jolicoeur P.
Can mental rotation occur before the dual-task bottleneck?.
J Exp Psychol Hum Percept Perform.
1994;
20
905-921
80
Lawson R, Humphreys G W, Jolicoeur P.
The combined effects of plane disorientation and foreshortening on picture naming:
one manipulation or two?.
J Exp Psychol Hum Percept Perform.
2000;
26
568-581
81
Dell'Acqua R, Jolicoeur P.
Visual encoding of patterns is subject to dual-task interference.
Mem Cognit.
2000;
28
184-191
82
Jolicoeur P, Dell'Acqua R.
The demonstration of short-term consolidation.
Cognit Psychol.
1998;
36
138-202
83 Hula W D, McNeil M R. Lexical frequency effects in dual-task picture naming. Presented
at: the 2007 Clinical Aphasiology Conference May 22–26, 2007 Scottsdale, AZ;
84
McCann R S, Remington R W, Van Selst M.
A dual-task investigation of automaticity in visual word processing.
J Exp Psychol Human Percept Perform.
2000;
26
1352-1370
85
Tombu M, Jolicoeur P.
Testing the predictions of the central capacity sharing model.
J Exp Psychol Human Percept Perform.
2005;
31
790-802
86
Pashler H.
Overlapping mental operations in serial performance with preview.
Q J Exp Psychol A.
1994;
47
161-191
87
Dell'Acqua R, Stablum F, Galbiati S, Spannocchi G, Cerri C.
Selective effect of closed-head injury on central resource allocation: evidence from
dual-task performance.
Exp Brain Res.
2001;
136
364-378
88
Dell'Acqua R, Pashler H, Stablum F.
Multitasking costs in close-head injury patients. A fine-grained analysis.
Exp Brain Res.
2003;
152
29-41
89
Dell'Acqua R, Sessa P, Pashler H.
A neuropsychological assessment of dual-task costs in closed-head injury patients
using Cohen's effect size estimation method.
Psychol Res.
2006;
70
553-561
90
Hula W D, McNeil M R, Sung J E.
Is there an impairment of language-specific processing in aphasia?.
Brain Lang.
2007;
103
240-241
91
Foygel D, Dell G S.
Models of impaired lexical access in speech production.
J Mem Lang.
2000;
43
182-216
92
Dell G S.
A spreading-activation theory of retrieval in sentence production.
Psychol Rev.
1986;
93
283-321
93
Levelt W J, Roelofs A, Meyer A S.
A theory of lexical access in speech production.
Behav Brain Sci.
1999;
22
1-38
94
Schwartz M F, Dell G S, Martin N, Gahl S, Sobel P.
A case-series test of the interactive two-step model of lexical access: evidence from
picture naming.
J Mem Lang.
2006;
54
228-264
95
Cutting J C, Ferreira V S.
Semantic and phonological information flow in the production lexicon.
J Exp Psychol Learn Mem Cogn.
1999;
25
318-344
96
Jescheniak J D, Levelt W JM.
Word frequency effects in speech production: retrieval of syntactic information and
of phonological form.
J Exp Psychol Learn Mem Cogn.
1994;
20
824-843
97
Griffin Z M, Bock K.
Constraint word frequency, and the relationship between lexical processing levels
in spoken word production.
J Mem Lang.
1998;
38
313-338
98
Schriefers H, Meyer A S, Levelt W JM.
Exploring the time course of lexical access in language production: picture-word interference
studies.
J Mem Lang.
1990;
29
86-102
99
Dell'Acqua R, Job R, Peressotti F, Pascali A.
The picture-word interference effect is not a Stroop effect.
Psychon Bull Rev.
2007;
14
717-722
100 Sullivan M P, Macchi C. A dual-task study of lemma selection in the picture-word
interference task: is competition strategically or automatically minimized?. Presented
to the annual meeting of the Cognitive Science Association for Interdisciplinary Learning,
Hood River, OR 2002
1
Considerable variability has also been demonstrated to occur across language modalities
(gesturing, writing, talking, reading, and listening) and across levels of language.
However, psycholinguistic operations unique to each processing modality appears to
account for a substantial amount of the variability. This source of within-subject
variability is not discussed here.
2
Navon and Miller
[63 ] and Tombu and Jolicoeur
[64 ] independently developed models that are mathematically identical. Tombu and Jolicoeur
referred to it as a central capacity sharing model. In this article, we adopt Navon and Miller's terminology , single resource.
3
Although it is acknowledged that capacity limits and/or processing bottlenecks may
occur in the pre- and postcentral stages under some circumstances, such limits are
proposed to be independent of and qualitatively different from the central bottleneck.
[54 ]
[67 ]
4
The predictions that RT1 will be affected by SOA and task 2 difficulty depend on a
number of assumptions, including the assumptions that the total available resource
capacity is limited and constant, or at least does not vary systematically with SOA
or task difficulty.
[63 ]
[64 ] Although these assumptions are arguable, they are helpful in making the models and
their predictions tractable, and detailed discussion of them is beyond the scope of
this article.
5
Although a manual high/low tone identification task may be subject to verbal encoding,
the degree of verbal processing for such a task should be minimal relative to that
required for a picture-naming task.
William D HulaPh.D.
Speech Pathologist, VA Pittsburgh Healthcare System
7180 Highland Dr. 132A-H, Pittsburgh, PA 15206
Email: William.Hula@va.gov