失語症病患(aphasic patients)的研究對於語言的運作機制提供了一些訊息，讓我們能從不同的角度認識大腦的運作。本篇研究的目的在於探討失語症病患的自我修補表現(self-repair performance)，我們利用一套具有五大自我修補項目的分類系統分析病患的表現並將參與研究的四位失語症病人區分為流利型(fluent)以及非流利型(non-fluent)病患，之後再分別將四位病人與其治療師一對一的各別談話錄音、譯寫。在流利型的組別之中，我們收集了207個威尼克病患(Wernicke’s aphasics)的自我修補語料，而在非流利型組別當中，則收集了347個布洛卡病患(Broca’s aphasics)的自我修補語料。 結果顯示，威尼克病患與布洛卡病患在自我修補的整體表現基本上是相似的，也就是說，在這五大項目的自我修補模式中，他們使用每一項的頻率是沒有顯著差異的。因此，我們認為自我修補是一種溝通能力的表現，而這樣的能力並不會受到病人各自的語言缺陷所影響。然而，我們得知兩種類型的病患在自我修補的表現上，依然具有一些細微的不同。威尼克病患使用了較多的填補模式(the completion pattern)，這或許與他們較流暢的表達能力有關係，因為他們能較不費力的把尚未完整說出的詞彙補述完成。布洛卡病患則是使用了較多的取代模式(the substitution pattern)，這或許是因為他們的理解能力較好，幫助他們監控了自己說話裡頭的錯誤並進而修正。 此外，比較中文正常說話者與失語症病患的表現，我們發現每一種自我修補項目被使用的比率亦是相似的。這種情況或許提供了一種證明，表示我們在使用自我修補的模式上，都有一種共同的傾向(universal tendency)。 總結來說，在自我修補的表現上，影響失語症病患的三個可能因素是1、在語言處理過程中的複雜度。2、不同類型病人各自具有的語言缺陷。3、每一種自我修補模式所具有的實用性。 / Studies of aphasic patients provide more information for understanding mechanisms of language processing, since we can know more details of the human brain from a different perspective. The purpose of this study is to investigate self-repair performance of aphasics. A classification system made up of five major categories was adopted to analyze their performance. We divided four patients into fluent and non-fluent groups and collected conversation recordings of these four therapist—patient dyads. In fluent group, 207 self-repairs were recognized in the conversation between therapists and Wernicke’s (fluent) patients. In the non-fluent group, 347 self-repairs were found in the conversation between therapists and Broca’s (non-fluent) patients. Results indicated that the overall self-repair performance of Wernicke’s (fluent) and Broca’s (non-fluent) aphasics was similar. That is, the distribution frequency in the five categories was not significantly different. We therefore suggest that the self-repair performance is a communication-oriented ability, and it is not interfered by specific language deficits. However, there were still subtle differences between the two patient groups. We speculate that the relative higher percentage of the completion pattern in Wernicke’s (fluent) group is due to their rather fluent production ability, since they can fulfill an unfinished word without too much difficulty. On the other hand, Broca’s (non-fluent) patients used more of the substitution pattern. That is, they can detect the problems within their own speech and further correct them. This could be attributed to the self-monitoring ability brought by their better comprehension. In addition, comparing with the studies of Mandarin normal speakers (Chui, 1996; Tseng, 2006), we found that the distribution frequency of each self-repair pattern in aphasic patients was similar with the distribution in normal speakers. This similarity might indicate a universal tendency of the self-repair use. In sum, there are three possible factors affecting the self-repair performance of aphasics, they are the processing difficulty, the linguistic deficits of different patients, and the value of the repair pattern.

published_or_final_version / abstract / Speech and Hearing Sciences / Doctoral / Doctor of Philosophy

Aphasia is an acquired general impairment of the language processes resulting from brain damage that is frequently caused by cerebrovascular accidents (CVAs). Persons with aphasia have a history of retaining important communication competencies that have the potential for helping them succeed in using augmented communication systems. Using augmentative and alternative communication (AAC) systems by adults with aphasia has been studied, but few studies have reported successfully using AAC systems in rehabilitating adults with aphasia. New advanced technologies including the availability of devices that talk, store a lot of information, and are relatively small can give AAC the potential to affect a greater change in functional communication skills for more persons with aphasia, particularly as experience with AAC rehabilitation grows. The purpose of the present study was to determine whether an adult with severe, nonfluent aphasia could communicate independently by adding a voice output communication aid (VOCA) to his natural communication repertoire. This study also sought to answer the following question: Does the addition of a VOCA to natural expression facilitate independent communication in an adult with severe, nonfluent aphasia? One subject was drawn from the out-patient members of a recreationoriented communication treatment group which is conducted at the Portland Veterans' Affairs Medical Center. The subject had been diagnosed with severe, nonfluent aphasia by a certified Speech/Language Pathologist. This study used a single-subject, component assessment research design to explore the relative effectiveness of components in an aphasia and AAC treatment package. It compared the relative effectiveness of Promoting Aphasics' Communicative Effectiveness (PACE) only treatment using natural communication strategies with that of PACE treatment for natural strategies plus a VOCA component. The subject's attempts to convey information were videotaped and analyzed using mean scores and a split-middle method of trend estimation to determine whether performance differences existed under two treatment conditions. The data for the number of conversational turns show an increase in the number of conversational turns which confirms an overall decrease in efficiency of communication for a severely aphasic person in this structured task in the augmented condition. Second, although the data for the number of communication breakdowns, the number of repair turns, and the repair turns as a percentage of total turns show a decline which would confirm an overall increase in effectiveness, this study does not conclusively demonstrate that the use of a VOCA enhances communication in this setting for this person compared to PACE only treatment. Lastly, the data for the number of messages conveyed correctly show little change which confirms by the measure used in this study, no difference in accuracy of communication for this activity in the augmented condition.

Thesis (Ph. D.)--University of Washington, 2000. / Vita. Includes bibliographical references (leaves 102-111).

Orientador: Regina Yu Shon Chun / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T18:44:27Z (GMT). No. of bitstreams: 1 DiGiulio_RafaelaMarques_M.pdf: 1132136 bytes, checksum: c7ecacdc23c99838a12fbf1e78c299bc (MD5) Previous issue date: 2011 / Resumo: INTRODUÇÃO: O acidente vascular cerebral (AVC) representa a terceira causa de morte em países industrializados. Além de alta incidência, a sequela mais comum de AVC é a afasia, o que traz sérios impactos sobre a qualidade de vida dos indivíduos. Os comprometimentos lingüístico-cognitivos e psíquicos repercutem nas relações entre a pessoa com afasia e seus familiares, geram a demanda de cuidados diferenciados e implicam a participação de um cuidador, geralmente um dos membros familiares. No âmbito da Fonoaudiologia, existem poucos estudos voltados aos cuidadores e/ou familiares na afasia. OBJETIVOS: investigar o impacto da afasia no cuidar de sujeitos afásicos fluentes e não-fluentes bem como nas relações de comunicação entre eles e seus cuidadores e/ou familiares. Esse estudo também procura verificar como a atuação fonoaudiológica, na ótica dos cuidadores e/ou familiares, pode contribuir para o processo de comunicação. SUJEITOS E MÉTODO: Participaram da pesquisa 18 cuidadores e/ou familiares de pessoas afásicas participantes de um Centro de Convivência de Afásicos do Instituto de Estudos da Linguagem/UNICAMP e do Grupo Fonoaudiológico de Comunicação Suplementar e/ou Alternativa do CEPRE/FCM - UNICAMP. Para a coleta de dados foram realizados quatro grupos focais (com uma média de três a sete integrantes), conduzidos pela pesquisadora. Os encontros foram gravados em vídeo e transcritos. Além disso, foram realizadas leituras do material, utilizando-se os critérios de repetição e de relevância para estabelecimento das categorias de análise. Foram estabelecidos dois grandes eixos temáticos para análise, o impacto da afasia (i) no processo de cuidar e (ii) nas relações de comunicação entre os sujeitos afásicos e seus familiares/cuidadores. RESULTADOS: Os resultados evidenciam o impacto que a afasia causa para o próprio indivíduo e para o seu cuidador e/ou familiar, com influências nas relações entre eles e repercussão no dia-a-dia da dinâmica familiar. Embora essa situação traga conseqüências para toda a família, comumente, o cuidado principal é assumido por um único familiar, geralmente cônjuges e filhos, o que gera mudanças no dia-a-dia dos cuidadores, com sobrecargas física e emocional, capazes de alterar sua qualidade de vida. Em relação à linguagem, verifica-se que a dificuldade em se expressar faz com que o cuidador, algumas vezes, exclua a pessoa afásica de conversas. Observa-se também que foram estabelecidas entre os afásicos e seus cuidadores e/ou familiares formas próprias de comunicação, sendo a CSA um recurso que se mostrou um importante instrumento para o favorecimento da linguagem do sujeito afásico. CONCLUSÃO: Os achados evidenciam que a dificuldade de linguagem afeta as relações sociais entre o sujeito e sua família/cuidador. Ademais, os resultados reiteram a necessidade de espaços que promovam momentos de escuta e acolhimento das demandas dos familiares, bem como salientam a importância da atuação fonoaudiológica com esse grupo / Abstract: INTRODUCTION: The cerebral vascular accident (AVC) is the third cause of death in industrialized countries. Besides its high incidence, the most prevalent sequel of AVC is aphasia, an acquired communication disorder that impairs a person?s ability to process language. Linguistic-cognitive impairments and psychological impacts on the relationships between the individual with aphasia and his family (the focus of this study) generate a need for special care, which involves the participation of a caregiver, usually a family member. From the perspective of Speech, Language and Hearing Science, few studies have focused on caregivers and family members in the treatment of aphasia. OBJECTIVES: To analyze the impacts of aphasia on the care process of patients (non-fluent and fluent), and to identify the impacts of aphasia on the communication between these patients and their caregivers and/or family members. This study also seeks to verify how the Speech-Language Pathology can contribute in the communication process from the perspective of caregivers and/or family members. SUBJECTS AND METHOD: Eighteen caregivers and/or family members of aphasic patients participated in this study. They are involved with Aphasia Center (CCA) of Institute of Language Studies (IEL-UNICAMP) and the group of Speech-Language Pathology of Augmentative and Alternative Communication (AAC) - (CEPRE/ FCM - UNICAMP). To collect the data we carried out four focus groups (with an average of three to seven members) led by the researcher. The meetings were videotaped and transcribed. In addition, there were readings of the material, using the criteria of repetition and relevance to establish the categories of analysis. We established two major themes for analysis: (i) the impact of aphasia on the care process and (ii) the impact of aphasia on the communication between the aphasic patients and their caregivers/family members. RESULTS: The results show that aphasia brings serious impacts on the relations between patients and their caregivers and/or families, which influence their routine and family dynamics. We also observed that even though the impacts of aphasia brings consequences for the whole family, usually the main care is assumed by a single member (spouses and daughters/sons), which generates changes in caregivers? routine with physical and emotional consequences, affecting their quality of life. Considering some difficulties of communication and comprehension, we observe that caregivers/family members, in general, exclude aphasic patients of meetings and regular conversations. We also observed that aphasic patients have tried to establish their own forms of communication. In these cases, it is common that the patients adopt the Augmentative and Alternative Communication (AAC), which is an important instrument for facilitating the language of individuals with aphasia. CONCLUSION: These findings highlight how difficulties of language can affect social relations between individuals with aphasia and their families/caregivers. Moreover, the results confirm the need for aphasia groups and aphasia centers, which can provide moments to listen to and embrace the demands of families of aphasic patients. The results also emphasize the important role of the Speech-Language Pathology practice with these all individuals, which can help reconnect persons with aphasia to their family members, and bring positive repercussions not only for the patients but also for those who are responsible for their care process / Mestrado / Saude, Interdisciplinaridade e Reabilitação / Mestre em Saúde, Interdisciplinaridade e Reabilitação

Submitted by Biblioteca Central (biblioteca@unicap.br) on 2017-11-16T23:23:51Z No. of bitstreams: 1 dissertacao_izabella_cristina_aguiar_gomes.pdf: 4159101 bytes, checksum: eb236f369f89df8e253e71da01606821 (MD5) / Made available in DSpace on 2017-11-16T23:23:51Z (GMT). No. of bitstreams: 1 dissertacao_izabella_cristina_aguiar_gomes.pdf: 4159101 bytes, checksum: eb236f369f89df8e253e71da01606821 (MD5) Previous issue date: 2010-07-30 / Aphasia is considered a reduction and dysfunction of the use of the language in which there is alteration of linguistic mechanisms in all the levels, shown in the expressive aspect how much in the receptive one of the oral and written language to different degrees in each type. The presupposition used in this work is that the language, while symbolic process, leaves from a social context, and acts like social practice, showing and working like oral and written activity in the constitutive activities of the man with which we can build senses. Between these two kinds of the language, the orality occupies a place of distinction regarding the writing in the studies on Aphasia. Before this, this work would be done to tackle the written production of the aphasic person in his relation with the orality, aiming to check in the written production of the aphasic at “possible” present marks of orality or not in the oral expression of this subject. For this objective, the written productions of 6 (six) subjects were selected. Aphasic people of both types, which announced and frequented regularly the Group of Familiarity for Aphasic people of the Catholic University of Pernambuco, during the period of 22 (twenty two) meetings. The studies for the presented subject were based on damages to the organization of the speech of the aphasic people and on the theoretical detailed studies on speech and writing, detaching the relation between these two kinds of the language. With that, one could check the presence of 10 (ten) types of marks of oralities in the written productions of the aphasic person involved in this work through activities with 6 (six) textual types developed through the realization of the Workshop of Speech and Written in the Group. When the correction is standing out by the most frequent mark of orality, this is present in the writing of 5 (five) subjects. The relevance of the work identifies characteristics and it offers strategies for overcoming of the difficulties faced by this citizen, looking to contribute to the development and improvement of the restoration of his language, using all the resources used by the aphasic person to communicate, when there is making possible an intervention which approach so much the speech as for writing, contributing to the readaptation of the orality and to a recuperation more effective of the language as a whole, promoting the social re-insertion of the aphasic citizen in his environment. Keywords: aphasia, relation between orality – written, textual types, mark of orality. / A afasia é considerada como uma redução e disfunção do uso da linguagem em que há alteração de mecanismos lingüísticos em todos os níveis, manifestando-se tanto no aspecto expressivo quanto no receptivo da linguagem oral e escrita, embora em diferentes graus em cada uma dessas modalidades. O pressuposto utilizado neste trabalho é o de que a língua, enquanto processo simbólico, partindo de um contexto social, atua como prática social, manifestando-se e funcionando como atividade oral e escrita, nas atividades constitutivas do homem, com a qual podemos construir sentidos. No entanto, entre essas duas modalidades da língua, a oralidade ocupa um lugar de destaque com relação à escrita nos estudos sobre Afasia. Diante disto, este trabalho irá enfocar a produção escrita dos afásicos em sua relação com a oralidade, visando verificar, na produção escrita do afásico, “possíveis” marcas de uma oralidade presentes ou não na expressão oral desse sujeito. Para este objetivo, foram selecionadas as produções escritas de 06 (seis) sujeitos afásicos, de ambos os gêneros, que participaram e freqüentaram regularmente o Grupo de Convivência para Afásicos da Universidade Católica de Pernambuco, durante o período de 22 (vinte e dois) encontros. Os estudos para o tema apresentado foram fundamentados em pesquisas sobre a organização do discurso do afásico e no aprofundamento teórico sobre fala e escrita, com destaque para os estudos sobre a fala e a escrita, a partir da perspectiva de Marcuschi (2007a), enfocando a relação entre essas duas modalidades da linguagem. Com isso, pôde-se verificar a presença de 10 (dez) tipos de marcas de oralidade presentes nas produções escritas dos afásicos deste trabalho, através de atividades com 06 (seis) gêneros textuais, desenvolvidos através da realização da Oficina de Fala e Escrita no Grupo, destacando-se a correção e o pouco uso de acentos e pontuação como os tipos de marcas de oralidade mais recorrentes, presente na escrita de 05 (cinco) sujeitos, e, a modalização, a repetição e a paráfrase como as menos recorrentes, presentes na escrita de apenas 01 (um) sujeito. A relevância do trabalho foi identificar características e oferecer estratégias para a superação das dificuldades enfrentadas por esse sujeito, buscando contribuir para o desenvolvimento e aprimoramento do restabelecimento de sua linguagem, aproveitando todos os recursos utilizados pelo afásico para se comunicar, de modo a possibilitar uma intervenção que enfoque tanto a fala quanto a escrita, colaborando na readequação da oralidade e em uma recuperação mais efetiva da linguagem como um todo, promovendo a re-inserção social do afásico em seu meio.

The body of work contained in this dissertation consists of seven studies investigating conversational skills in people with aphasia (PWA). The predominant focus is on establishing reliable measures of language skills in unstructured conversation in PWA. Overall, ten measures are investigated, and much of the work is concerned with establishing interrater reliability and test-retest stability. These measures are needed to determine generalization of aphasia intervention to conversation, to inform treatment decision-making, and to develop future interventions that have the capacity to improve language abilities at a conversation-level. The initial work focused on microlinguistic skills (i.e., word and sentence-level language; Leaman & Edmonds, 2019a; 2019c), and then evolved to include macrolinguistic skills (discourse-level language) with a focus on global coherence (Leaman & Edmonds, in press) and topic initiation (Leaman & Edmonds, 2020). In addition, questions emerged regarding: a) the relationship of language production in monologue and in conversation (due to the predominance of monologue testing, as opposed to conversation, in clinical environments; b) normative data for the measures in monologue and in conversation; c) the sensitivity of the measures as treatment outcome measures. Research questions regarding items a and b are addressed in the novel research conducted for the dissertation (reported in the last two manuscripts in this document, i.e., Dissertation Studies 1 and 2 (DS1 and DS2)), and item c is addressed in Obermeyer et al., (in press). In addition, a related outcome of this research is a methodology, The Conversation Collection Protocol (CCP). The CCP was developed to consistently collect unstructured conversations that would have similar interactional features that could be used as language samples. The protocol is based on conversational interactions in typical speakers, and is primarily informed by the Conversation Analysis literature (for an overview see Schegloff, 2007). The CPP was piloted to train SLP conversation partners to use typical, familiar, social, adult-style interactions during the conversations (rather than traditional therapy or instructional behaviors) in the first study (Leaman & Edmonds, 2019a). The protocol was further developed prior to data collection for the dissertation studies. In this development phase, the systemized training protocol was expanded to include excerpted readings from literature regarding conversational interaction, and a post-training quiz for the partners. In addition, a session fidelity protocol was developed and implemented. Use of the CCP in all of the studies contributed to achieving similarity in the SLP partners’ interactional styles across conversational dyads, allowed fostering of social conversations which were desired (i.e., as opposed to interview-style conversations often used in the literature), and promoted the PWA to direct their own communication decisions and topics of discussion which in typical therapy interactions may be drastically limited by the clinician (Simmons-Mackie & Damico, 1999). The CCP resulted in high session fidelity (98-99%) across the 27 SLPs who participated in the two dissertation studies. The CCP training also resulted in a corpus of conversations that are similar in content and complexity (measured by mean length of utterance and type-token ratio), with similar topics and an equitable distribution of topic-initiating utterances between the PWA and the partners (Leaman & Edmonds, 2019a; DS1). This research agenda is motivated by a clinical need and vision for a dramatic shift in aphasia intervention, which moves away from structured, decontextualized therapy tasks and towards use of everyday conversation as the primary vehicle of intervention. Prerequisite to development of such an intervention is development of outcome measures capable of capturing real-world changes in conversation. Without such measures, it is not possible to determine whether treatment has the intended effects on conversation. Because conversation is a complex, multi-modal, and contextually-bound phenomenon, treatment that improves everyday conversation could potentially affect many aspects of communication. Change in conversation can be realized by treatment focused on verbal skills, nonverbal skills, compensatory strategies, participation, and/or partner training, and ideally should combine all of these communication parameters. Currently, measures and scales exist for each of these areas, except for in the area of language ability in conversation. It is this clinical and research gap, the lack of reliable measures to evaluate language in its most commonly used context, conversation, that fuels this line of research. The publications, in press manuscripts, and two manuscripts resulting from the dissertation research are presented in their order of publication. Conclusions, clinical implications, and future directions are presented in each. However, in brief summary, the primary findings of this body of work are: 1. Reliability and Stability of Language in Conversation Measurement of language production skills in PWA can be accomplished with a high-level of reliability and stability for all measures investigated except for: a) the measure of behavioral manifestations of lexical retrieval (LEXoth; Leaman & Edmonds, 2019a); and b) referential cohesion (REF), which demonstrated variability that precluded test-retest stability in two studies (Leaman & Edmonds, 2019a; DS1). The clinical implication is that language in unstructured conversation, for certain measures, is reliable and stable. 2. Language Production Relationships in Monologue and Conversation Language production in monologue does not tend to parallel language production in unstructured conversation, thus performance during monologue therapy tasks cannot reliably predict conversational language production for most measures investigated (DS2). Consequently, language findings based on a monologue task (this research used a story narrative monologue) cannot be extrapolated for understanding of conversational language skills for most of the measures investigated. Thus, if the desired outcome of treatment is impact at a conversation level, evaluation of the effectiveness of the intervention to achieve this aim cannot be estimated with use of a story narrative monologue language sample. Further, development of intervention relevant to language needs in conversation cannot be adequately developed based on a story narrative monologue. Further investigation is needed regarding the relationship between single picture description tasks and conversation in terms of language production skills. 3. Topic Initiation Mechanisms in PWA and Their Partners PWA often use similar mechanisms to alert listeners that a new topic is being initiated as their communication partners without aphasia, such as waiting for an old topic to end, or using a marker like “oh, and by the way…”. In interactions between individuals without communication disorders, these mechanisms are often layered and used simultaneously. However, the findings of this research demonstrate that as aphasia severity increases, individuals use fewer simultaneous mechanisms to introduce topics. In addition, for people with moderate to severe aphasia, the fewer topic initiation mechanisms they use, the less successful they are during their topic initiating utterances (Leaman & Edmonds, 2020). This work provides a broader analysis of topic initiating behaviors in PWA with a larger sample size (n=10) than had been previously available. In addition, it established a needed methodology for locating the beginning and end of topic locations in unstructured conversation. This ability to reliably locate topics within conversation is also key to the subsequent research regarding global coherence in conversation, which depends on analysis of each utterances coherence to the overall topic being discussed (Leaman & Edmonds, in press; DS1). An important clinical implication suggests that explicit teaching PWA to use simultaneous methods of topic initiation may have therapeutic benefit to support a greater level of successfulness when they initiate new topics during conversation. Further, teaching both PWA and their regular partners about mechanisms of topic initiation may facilitate improved awareness of these mechanisms with positive therapeutic effect in conversation. 4. Sensitivity of Linguistic Measures as Post-Treatment Outcomes Evidence of stability and sensitivity of linguistic measures in conversation is provided in an intervention case study (Obermeyer et al., in press). As a case study, this research suggests preliminary evidence that a discourse-level intervention (Attentive Reading and Constrained Summarization -Written) can affect change in conversation, and that measures investigated in the research presented here may be sensitive to such change. 5. Development and Use of the CCP to Train SLPs as Conversation Partners Although not addressed as a research question, the CCP appears to be effective as a systematic method to collect unstructured conversations suitable for language analysis. Further, the CCP training is brief (less than an hour), and a large group of SLPs (27) demonstrated learning and adherence to the protocol, as evidenced by high session fidelity and resulting conversations that are similar in terms of vocabulary use frequency, mean length of utterance, type-token ratio, and even distribution of topic-initiating turns between the PWA and their partners, and similar topical content across the conversations (Leaman & Edmonds, 2019a; DS1). Further, in the dissertation research over 90 conversations were collected using the CCP training (some were not analyzed due to subsequent ineligibility of the participant), and no conversation resembled an interview or traditional didactic therapy interaction. The clinical implication is that SLPs can be efficiently and effectively trained as conversation partners to collect unstructured (social) conversational samples for the purpose of assessment. Next steps in this line of research are detailed in the conclusion of each of the seven articles and manuscripts. In addition, a summary of the findings and future directions based on the entire body of work are included in the Epilogue of this dissertation.

This chapter presents information on aphasic auditory abilities, with specific reference to the following areas: (1) time-altered speech; (2) auditory sequencing ability of aphasics; (3) auditory discrimination ability of aphasics; and, (4) auditory perceptual disturbances cause by lesions in the left temporal lobe. Information will also be presented on the role of distinctive features in speech perception. Finally, the statement of the problem will be posed.

It is obvious that the effects of speaking rate on the ability of aphasic children to comprehend verbal material has not been extensively researched. The studies cited above suggest that an increase in rate adversely affects comprehension by various subjects, while a decrease in rate may improve comprehension by certain subjects. Therefore, the present study attempted to examine the effects of the rate at which an auditory stimulus is presented to aphasic and normal children.

Made available in DSpace on 2016-04-28T18:23:31Z (GMT). No. of bitstreams: 1 evelin.pdf: 430173 bytes, checksum: 33f50b1ffce8b44d54a08f3d3c74f9b5 (MD5) Previous issue date: 2007-05-18 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Aphasic speech constitute a challenge for language therapy for presenting itself as hesitant, elliptical and incomplete characteristics which often produces a cohesion disarrange and, consequently, a dialogical disturbance. Aphasia can be taken as an striking example of what has been described by Lier-DeVitto (2006) as a disturbance in speech which destroys the illusion of the speaker of being in control of hers/his own speech, thus tearing apart the social tissue in which it is involved (my emphasis). Dialogue - even when ambiguous and full of misunderstandings is the privileged bonding mechanism between speakers. It constitutes, thus, the basis for clinical intervention. In fact, it is through dialogical processes that the aphasic patient changes his/her position in relation to its own speech or the speech of others. It is, therefore, of importance to reflect upon the complexity and heterogeneity of dialogues as well as on the interactional asymmetry which is alleged part of the dialogical process in clinical settings (SALAZAR-ORVIG 1998, among others) an asymmetry which does not take into account the specific theoretical/clinical features of dialogues involving normal and symptomatic speeches. This dissertation assumes dialogue as an asymmetric exchange (in the sense of a non-coincidence between speakers) and aims at discussing the nature and functions of dialogical processes in various therapeutic approaches. Such a point of view distances itself both from behavioristic and from social approaches based on the notion of shared knowledge it is, instead, directed towards the idea of dialogue as the driving force behind the changes that take place in patients speech. The discussion will be illustrated by clinical material / O encontro com falas de sujeitos afásicos é, reconhecidamente, um desafio clínico para o fonoaudiólogo, dada sua natureza hesitante, elíptica, incompleta, que, na maioria das vezes, promove perturbação coesiva no tecido textual-enunciativo. Essas falas afetam o diálogo. A afasia é um dos casos mais expressivos do que disse Lier-DeVitto (2006): um desarranjo na fala que destrói a ilusão do sujeito de estar na origem [ou em controle] de seu dizer e que esgarça o laço social (ênfase minha). O diálogo, mesmo quando perpassado de modo significativo por ambigüidades e mal-entendidos, é o mecanismo privilegiado de enlace possível entre seres falantes. Ele é, então, solo de sustentação do tratamento clínico. De fato, no jogo dialógico, mudanças na posição do afásico frente ao dizer do outro e ao próprio dizer, ocorrem. Torna-se, portanto, relevante refletir sobre suas configurações complexas e heterogênias complexidade que remete à alegada assimetria interacional (SALAZAR-ORVIG,1998, e outros). Assimetria que não tangencia a problemática clínica e/ou teórica de eventos dialógicos em que estejam envolvidos falantes sintomáticos e falantes normais de uma língua. Este trabalho discute a natureza e as funções do diálogo em diferentes propostas terapêuticas e alinha-se à concepção de diálogo pautada na idéia da irremediável dessimetria (não coincidência) entre falantes. Nesse sentido, ele toma distância, seja de vertentes comportamentalistas, seja de vertentes que o aproximam de interação social em que ele seria sustentado pela construção de conhecimento mútuo . Neste trabalho, falas afásicas e seus efeitos na clínica motivam a reflexão que aqui são desenvolvidas. Propõe-se o diálogo como locus de promoção de mudanças. Segmentos de situações clínicas serão incluídos para ilustrar a discussão