Verbal Paraphasias of Aphasic Patients in the Course of Naming Actions

Verbal Paraphasias of Aphasic Patients in the Course of Naming Actions E. S. BEYN, 1. T. VLASENKO

Scientific Research Institute of Neurology, USSR Academy of Medical Sciences

Formulation of the Problem and Theoretical Pre-Peculiarities for Singling out and Classifying Some Types of “Action” Paraphasias

According to data published in the literature (A. Pick, 1913; 1931; F. Lotmar, 1919; K. Goldstein, 1960; P. Y. Galperin and R. A. Golubova, 1933; M. S . Lebedingsky, 1941 ; B. G. Ananiev, 1946; E. S . Beyn, 1958, 1970), there is no doubt that the emergence of most verbal paraphasias in aphasic patients is mainly due to a compensatory semantic reconstruction of the deranged speech system, and that owing to the difficulty of actualizing the words, this reconstruction is intimately connected with mental and verbal psychological operations*. However, the question concerning the character of the concrete psychological operations in the course of searching for the required word (the degree to which they are generalized, reduced, automatized, etc.) still remains open.

The connection between certain verbal paraphasias with different clinical forms of aphasia and the degree of gravity of the speech disorder has also been insufficiently studied, just as the place and role of verbal paraphasias in the changed correlation of internal and external speech of aphasic patients.

It should be pointed out that most authors analysed verbal paraphasias in oral speech without taking into consideration that the psychological structure of various forms of oral speech (naming objects, repetition of words presented orally, spontaneous speech, etc.) is far from being similar. The above-mentioned authors did not make any distinc- tions between paraphasias emerging when an object is designated verbally and the repeating of them when an action is named, though they differ essentially as regards their psychological and linguistic content. It seems to us that this approach determined also a certain “amorphousness” of the ideas of verbal paraphasias arising in different forms of oral speech in aphasic patients.

In our opinion, a correct solution of some aspects of the problem of causes originating a speech utterance, which in respect of its significance now takes one of the leading places in psycholinguistics (A. A. Leontiev, 1969), to some degree depends on the solution of the aforesaid and many other questions, connected in some way or other with the psychological mechanisms of the process of “word searching”.

Before expounding our data we deem it necessary to define the structure of a “word- notion” which designates an action.

It is known that the meaning of a word implies the aspect ofits content. This aspect of a word-notion, including that which designates action, covers not only information *Characteristic of some modern authors (Lor A. Calvi, 1959; V. Pelican, 1965, 1966) is their formal approach to studying verbal paraphasias; a distinctive feature of this approach is full or almost full disregard for latent psychological law-governed phenomena wluch determine the emergence of verbal replacements.

24

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VERBAL PARAPHASIAS OF APHASIC PATIENTS I N THE COURSE OF NAMING ACTIONS 25

directly expressed by the utterance of the word, but also all the essential attributes, all the concomitant connections and relations potentially possessed by the objects which are designated by the word (A. A. Leontiev, 1970). In other words, the structure of the content of a word designating an object potentially possesses not only denotative properties (relating directly to the object of thought), but also conotative ones (concomitant to “semantic stratifications”).

When we pronounce the verb “forges”, we generalize and produce a great amount of information including not only information concerning the process of interaction of definite objects (the process of forging), but also the objects themselves entering the structure of the designated action as component elements.

As is known, the action itself, for example, the action of forging designated by the word “to forge” or “forges”, has a complex structure. It presupposes the indispensable presence of the following basic static elements: (1) the blacksmith, (2) the object of forging, (3) the hammer, (4) the tongs, (5) the anvil, and (6) the blacksmith shop. These static elements begin to interact with the active participation of the blacksmith. The action of the latter may in its turn be presented as a number of interconnected operations (dynamic elements), i.e. in the form of a process: the blacksmith is standing; he is holding a hammer raising it, striking a piece of iron, watching its form, etc. All these interacting operations and links are generalized in the word-notion “forges”, the principal (predominating) aspect of the meaning of this word being the generalized dynamics of the interacting objects, i.e., the process itself, since the expression of the process is the main and leading attribute of the verb.

In order to analyse action paraphasias, it is also necessary to take into account the psychological laws of the naming process. From the observations of V. M. Kogan (1962), A. R. Luria (1969,1970) and L. S . Tsvetkova (1972) it may be concluded that the speech process of naming an action is always preceded by a primary reflection of the objects which participate in the action ; only subsequently the most informative attributes of the process (operations) become singled out and a corresponding word alter- native comes to life in the consciousness.

These ideas of the content of the structure of words-notions which designate actions and the process of naming actions were used by us as a theoretical basis for describing and analysing most verbal replacements arising in the course of naming actions.

Materials and Methods The general purpose of the investigation was to describe and analyse various types of “action” paraphasias of patients with acoustico-gnostic sensory and motor (efferent) aphasias of different degrees of gravity. This is particularly important, since we have not met in the literature any analysis of paraphasias emerging in the course of naming actions.

The study material of the present investigation consists of verbal replacements which arise only in the course of narnirig realistically portrayed actions (and states) of objects.

When selecting the material of action paraphasias, we applied the traditional experi- mental test of “naming objects (actions, attributes)”, but somewhat modified by us.

This modification of the research method consisted in additional stimulating instructions aimed at an “active search” for verbal replacements by the subjects. The aim of such an activating method, according to E. Bay (1964) and G . Sollberg (1965), is to create for the aphasic patient a situation of “indispensable naming”, which leads to an increase of the number of verbal paraphasias. These stimulating instructions greatly

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26 BRITISH JOURNAL OF DISORDERS OF COMMUNICATION

contribute also to an extension of the verbal search and thereby to bringing the process of word searching to the outside by the patients.

Pictures of concrete actions (or states) of objects were presented to the patients in turn (50 pictures to each patient). The actions or stimuli were selected from diverse spheres of human activity: the blacksmith is forging, the boy is chopping, the seamstress is sewing, the glazier isfixing a window-pane, the gardener is planting a tree, the peasant is mowing, etc.

When presenting the stimuli in turn, we at first gave the usual instruction which induced the patient to name the portrayed action. If the action was not named by the patient, or named not by a single word - a verb, but by a whole extended phrase, an additional speech stimulation was given: “Still try to name the action,” “What is the man doing?” “Try to find the word, maybe you will recollect it. Name the action by using one word - one verb!”

Altogether 33 aphasics were investigated, including 12 patients with sensory aphasia and 21 - with motor (efferent) aphasia.

Two subgroups characterized by different levels of speech disorders were marked out in each group of patients with sensory and motor aphasia on the basis of certain clinical and psychological criteria : one subgroup included patients with a light degree of gravity of the speech disorder, and the other - with a medium degree. At the same time within the group of patients with a medium degree of expressiveness of the speech disorder we singled out subgroups with a light and medium gravity of the disturbance of the nominative function proper.

The clinical composition and number of investigated patients with different forms of aphasia, including their subgroups, are presented in Table 1.

Table 1

Composition of the investigated patients. ~ ~ ~ ~ ~ _ _ _ _ _

Clinical form Groups of patients Sensory Motor with different degrees aphasia aphasia

of gravity of speech and naming disorders* N 1 (s.d. light; n.d. light) 4 4 N 2 (s.d. med. ; n.d. light) 2 I 1 N 3 (s.d. med. ; n.d. med.) 4 6 N 4 (s.d. med.; n.d. cons.) 2 -

-___ ~

Total 33

The abbreviations within the brackets mean: s.d. light - light degree of the speech disorder, n.d. light - light degree of the naming disorder, n.d. med. - medium degree of the naming disorder, s.d. rned. - medium degree of the speech disorder, n.d. cons. - considerable degree of the naming disorder.

The total number of stimuli presented to different groups of patients and of verbal paraphasic reactions provoked by them are given in Table 2. These data will be further utilized when analysing the types of verbal paraphasias.

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VERBAL PARAPHASIAS OF APHASIC PATIENTS IN THE COURSE OF NAMING ACTIONS 27

Table 2

Number of paraphasias in the groups of investigated patients (above the line - stimuli; below the line - paraphasias)

Clinical form Groups of patients Sensory Motor with different degrees aphasia aphasia

of expressiveness of speech and naming disorders* N 1 (s.d. light; n.d. light) 200 200

85 80

N 2 (s.d. med.; n.d. light) 100 556 91 285

N 3 (s.d. med. ; n.d. med.) 200 300 171 226

N 4 (s.d. med.; n.d. cons.) 100 - 99

Total 600 1056 446 591

.___-_ -

Denotations - same as in Table 1 .

A Qualitative Analysis of Paraphasias All the paraphasias provoked in the course of naming actions were systematized by us in the form of separate types (altogether 7 types) presented in Table 3.

It is known from the literature that object paraphasias, which in respect of their mechanisms of emergence correspond to the 1st and 2nd types of action paraphasias established by us (Table 3), clearly differentiate the basic aphasic syndrome (M. S. Lebedinsky; E. S. Beyn, I. T. Vlasenko, 1971). But, as can be seen from the table, at this stage of analysis the action paraphasias of the 1st and 2nd types do not help to differentiate various aphasic forms. Besides, they do not provide anything essentially new (in comparison with the analysis of object paraphasias corresponding to these two types). This is why we shall confine ourselves in the present work to the data contained in Table 3.

Of paricular interest are verbal replacements belonging to the 3rd, 4th and 5th types. Paraphasias of the 3rd type are defined by us as “Replacements (substitution) based

on a visually perceived static element singled out from the general composition of the action”. Replacements of this type manifest themselves externally in a non-differentiated grammatical category (a noun is actualized instead of a verb); they reflect the pathological adynamism of the internal search and a strict dependance of the process of word actualization which designates the action on the visually perceived objects of this action.

For example, from such verbal paraphasias of the 3rd type as: instead of the verb “repairs” - “watch-maker”, “watch” instead of “forges” - “hammer”, “tongs” “blacksmith’’, etc, it is clear that the phenomenon of a non-differentiated grammatical category (when instead of a verb, it is a noun which becomes actualized) is due to the fact that

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only static (in the given case secondary) elements are singled out from the general structure of the action. As to the attributes of the process, i.e. the dynamic (operational) elements of the action proper, they are not actualized by the patients at all.

Action paraphasias relating to the next (4th) type radically differ in their nature from replacements of the 3rd type. Their emergence is in the main due to the singling out and incomplete generalization by the aphasic patients of substantial dynamic elements (or attributes offthe process) of action which constitute, as it is well known, the basic content of the semantic structure of the verb. As shown by analysis, these replacements arise :

a. when one dynamic (operational) element is singled out from the general composition of the action (instead of “sewing” - “piercing”, “tying”, “turning up”).

b. when an equivalent dynamic attribute or an attribute of a higher level of generalization is singled out (instead of “forges” - “chops”, instead of “draws” - “writes”).

As shown by a psychological analysis, in paraphasias of subtype (a), which includes “Replacements based on a dynamic (operational) element singled out from the general composition of the action”, certain operations entering the composition ofthe designated action are, as it were, objectivized in speech. In other words, only separate operational attributes of the semantic content of the verb are generalized in these replacements, and therefore the generalization on the whole is incomplete.

It is known, for example, that the word “to sew” means a corresponding action which presupposes a chain (system) of concrete operations following one another and performed simultaneously (“sitting at a sewing machine”, “fixing a thread”, “turning up the material”, “piercing it with the needle”, “stitching”, etc.) which in human consciousness in ontogenesis by way of generalization, reduction and automation (P. Y . Galperin, 1957; A. N. Leontiev, 1965 and others) turned into a notion (“mental action”) fixed in the word “to sew”.

From the above examples it is quite clear that when the word “to sew” is actualized for the patients (by presenting them the action which it designates), there arise involuntarily such replacements as “stitching”, “piercing”, “overcasting”, “tying up”, “turning down”, etc. Here is another example. When the action of planting a tree is presented, there arise such replacements as “digging”, “lowering”, “raking” and others. The word “to repair” (a watch) is replaced by such verbs as “to wind”, “to fix”, “to screw” up”, “to turn”, etc.

It can be easily seen that these paraphasias clearly reflect the patients’ “narrowed” apprehension of the content of the process expressed by the verb sought for by them.

Paraphasias of subgroup (b) which includes “Replacements based on equivalent (but secondary) dynamic attributes, or attributes of a higher level of generalization singled out by the patients” - also reflect either the patients’ narrowed apprehension of the semantic content of the verb sought for though to a lesser degree than in the replacements of subtype (a) or its too extensive apprehension.

Such replacements as instead of ‘yorges” “chops”, instead of “draws” - “writes”, instead of “embroiders”- “sews” or “knits”, etc., reflect the act of singling out a whole complex of homogeneous operations both for the presented and for the actualized in the paraphasia action.

For example, in such actions as forging and chopping the operations which are performed have many homogeneous elements as regards both their appearance and essence: the subjects of the action are standing almost in similar working postures, holding externally similar instruments of labour, performing almost similar movements, etc.

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Verbal paraphasias of the 5th type (“Replacements-neologisms”) are close to the paraphasias of the 4th type in respect of the mechanisms of their emergence and can be rightfully related to “dynamic” replacements, since they emerge, just as the preceding ones, on the basis of a dynamic (operational) element singled out from the general composition of the action. However, the difference is that in the first case the dynamic attribute singled out by the patient leads to the actualization of the word whichdesignates either quite a different action, or a component part of the designated action, whereas in paraphasias-neologisms a new verb (an “individual word”) reflecting some dynamic attribute is being created according to all grammar rules. This type of replacements is in the main encountered in patients with sensory aphasia. For instance, patient 5 used instead of the words “he is smelling” - “he is breathing” (in a perverted form), instead of “knitting” - “netting” (the Russian verb was also perverted). Patient M. said instead of “shooting” - “bullet-throwing”, and “bullet-hitting”. Patient L. said instead of “smelling” - “blowing” (forming quite a new Russian verb).

Thus, as we can see, verbal replacements-neologisms express the so-called “word- creation” of the patient in conditions when the actualization of the words-names presents difficulties.

Such are the qualitative characteristics of the “dynamic” action replacements (4th and 5th types) which in respect of the mechanisms of their emergence, as shown above, radically differ from action paraphasias of the “static” 3rd type (this name is conven- tional), since their emergence is based on the principal aspect of the meaning of the verb (i.e. the aspect of its content).

A quantitative distribution of the verbal paraphasias according to the above- described types in each group (and subgroup) of patients previously established by us (see Table l), is given in Table 3.

As it may be seen from the table, in patients both with sensory and motor aphasia the action paraphasias do not show any essential law-governed phenomena. Most interesting is the distribution of paraphasias of the “static” and “dynamic” types.

The data presented in the table show that action paraphasias of the “dynamic” character (4th and 5th types, 62.5%) are considerably more inherent in patients with motor aphasia of a light degree of expressiveness (group 1) and less inherent in paraphasias of the “static” 3rd type, 31.3 %).

The differences of the relative values are statistically significant : 80 observations* ; t=4*16 p<O.OOl.

With an increase in the gravity of the principal aphasic syndrome (a medium degree of gravity, groups 2 and 3) the statistical correlation of these types of replacements which differ from each other is changed as well: the number of paraphasias in both types are theoretically equalized due to an increase of the number of “static” paraphasias and a decrease of the “dynamic” ones. In group 2, where the total number of replacements is 285, t= 1-92, the differences between the compared relative values (42.5 and 50.5) are inconsiderable. In group 3 these differences (45.1 and 48.7) are also insignificant (number of cases 226, t=0-77).

In patients with the sensory form of aphasia the quantitative distribution of action paraphasias of the “static” and “dynamic” types markedly differ from the distribution of replacements of these types in patients with motor aphasia.

The data of Table 3 show that in patients with a light form of sensory aphasia (group 1) paraphasias of the “static” type are fully absent, whereas the number of “dynamic”

*The total number of paraphasias in each sub-group of patients is shown in Table I .

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replacements increases to 90.6%. In all other groups (nos. 2, 3, 4) there takes place a statistically significant prevalence of “dynamic” paraphasias over replacements of the “static” type in spite of a general increase of gravity of the basic aphasic syndrome (a medium degree of gravity). Group 2: number of replacement cases - 91, t=2-12, p<0.05; group 3: number of cases - 171, t=6.21, p<O.OOI; group 4: number of cases - 99, t =4*13, p < 0.001.

Discussion and Conclusions In the literature which is known to us we have not met any attempts to single out, classify and describe more or less systematically the psychological mechanisms of action paraphasias. The entire, quite extensive literature dealing with this problem is devoted, as stated above, to studying the verbal replacements arising when it is necessary to designate or produce the names of objects, while expressing thoughts. In this connection it is important to discuss the following three principal questions.

1. What are the concrete psychological mechanisms responsible for the emergence of action paraphasias of different types and which probable connection with the dynamic internal speech can be deduced from them?

2. Do any types of action paraphasias reflect substantial peculiarities of different aphasic syndromes?

3. What is the similarity and difference between action verbal replacements arising in the course of naming actions and those which emerge when designating objects?

But before analysing the mechanisms which are responsible for the emergence of action paraphasias of different types we deem it necessary to substantiate in brief the point of view that some verbal reactions differing from others and included by us in type 3 (“static replacements” for example instead of “forges” - “hammer”, “tongs”, instead of “repairs” - “watchmaker”, “watch”; etc.) may be and must be regarded as paraphasias.

The examples cited in the present article show that a verbal reaction of the 3rd type fully accords in its general characteristics with the principal characteristics of verbal paraphasias described by many authors (M.S. Lebedinsky, E. S . Beyn). Firstly, word replacements of this type (just as action paraphasias of other types established by us) arise when the patients experience certain difficulties in the process of actualizing the word meanings ; they reflect both the generalizing function of speech and the defectiveness of internal speech at some stage of the word - generation. When pronouncing the word, the patients apprehend such paraphasia as an adequate designation of the object; and only after i t they may sometimes realize that it is erroneous. It should be remembered that the defectiveness of the generalizing function of the word - in action paraphasias of the 3rd type - is testified to by their narrowed semantic content: they express only the static components of the action and ignore those which relate to the process.

This, apparently, gives grounds to assume that a tendency towards static paraphasias in the patients’ internal speech in the process of searching for names arises at the stage when the attributes relating to the process of the portrayed action must be singled out. Probably, no such singling out takes place because of the pathological adynamism and and disautomatism of the internal speech which are inherent in aphasic patients, as well as of a disposition to sticking.

Unlike paraphasias of the “static” types, “dynamic” replacements (4th and 5th type) reflect a more generalized, or, in other words, a genetically higher, intra-speech stage of generating the word which designates a given action. It is “more generalized”

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because not only static components of the action, but also those which relate to the process are singled out (abstracted) in the3e rep1ac:ments.

However, replacements of the “dynamic” (4th) type/subgroup (a) and subgroup (b) also indicate the patients’ poor apprehension of the semantic structure of the verb sought for, since only secondary, unessential dynamic attributes are singled out and generalized in internal speech in the process of naming an action.

The difference between paraphasias of subgroups (a) and (b) is that the former are caused by the sticking of the internal speech processes at the stage when distant attributes of the process are singled out and selected, while the latter are caused at the stage when closer (or more similar) dynamic operations of the named action are singled out.

Let us now revert to the discussion of the problem of action verbal paraphasias in connection with the state of internal speech in aphasic patients.

Whereas previously it was assumed that the emergence of paraphasias is globally connected with the state of internal speech, now we try to analyse the psychological mechanisms of word replacements in connection with different supposed stages of word-actualization in the process of an intra-speech search.

In this connection it is important to remember that verbal paraphasias always emerge involuntarily; they inevitably reflect, like a focus, the pathological attributes which are peculiar to an intra- speech process at the moment when the patient actualizes the word or name. Therefore, all the types of aphasia and each type taken separately to some degree reveal the corresponding intra-speech stages of the process of actualizing a word and its meaning.

From this point of view the action paraphasias, which are so heterogeneous as regards the mechanisms of their emergence, as it were, expose qualitatively different levels of internal speech in the process of naming a portrayed action: 1. a stage when static components of the action are primarily singled out (reflected in replacements of the 3rd type); 2. a stage when any dynamic attributes of the action are globally singled out (reflected in replacements of the 4th type); 3. a stage when dynamic attributes of the action which are close in their content are differentially singled out (reflected in replacements of the IV-b type); 4. a stage of structuring the verb grammatically (partly reflected in replacements-neologisms of the 5-th type); 5. a stage when generalized distinctive attributes are adequately singled out and proper grammatical structuring of the verb takes place (reflected in the actualization of an adequate word-name).

At the same time action paraphasias (each type in its own way) reveal a disturbance of the general dynamics of the intra-speech process at the moment of word searching. In aphasic patients, as distinct from normal subjects, the search for the required word is disautomatized, extended and unsystematic; this allows us to assume that in the process of selecting attributes at different stages of word actualization some unessential attributes playing the role of supports are singled out, which leads to the emergence of replacements of a corresponding type.

Finally, it should be pointed out that verbal paraphasias present a systemic mani- festation of an aphasic disorder. A statistical analysis shows that action paraphasias of different types are peculiar to various aphasic syndromes and that any paraphasias reflect essential aspects of corresponding aphasic forms (see Table 3).

In this respect paraphasias of the 3rd type are characteristic of patients with motor aphasia. An increased number of “static” replacements in patients with a medium degree of gravity of the speech disorder and a decreased number of “dynamic” replacements present a direct expression of the so-called “verbal (action) weakness” which is one of the essential symptoms of a motor-speech disorder. It may be, apparently,

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assumed that the psychological mechanism governing the emergence of these replacements is of the same nature as the phenomenon of telegraphic style, as well as a considerable disturbance of internal speech, which is characteristic of patients with the given clinical form of aphasia.

On the other hand, the statistically significant prevalence of “dynamic” paraphasias in the group of patients with a light degree of expressiveness of motor aphasia indicates a considerable rehabilitation of the disturbed predictive side of speech in these patients.

As to patients with sensory aphasia, particularly characteristic of them is a distribution of paraphasias of the “dynamic” type. A statistically significant prevalence of these paraphasias over “static” replacements in patients with a medium degree of gravity of the speech disorder reflects a characteristic feature of the speech of patients with sensory aphasia - a relative intactness of the dynamics of internal speech, its predicative saturation. The complete absence of “static” paraphasias in patients with a light degree of the speech disorder presents an additional confirmation of this proposition.

An analysis of paraphasias-neologisms shows that they reflect with particular clarity the process of the patients’ word-creation during which the grammatical realization of the word proper (i.e. its grammatical structuring) remains intact. And the fact that paraphasias-neologisms are encountered in patients with sensory aphasia several times more often than in patients with motor aphasia (see Table 3) is also one of the characteristic peculiarities of this aphasic form. This testifies to a relative intactness in these patients of the grammatical sides of speech, which was already pointed out by one of the present authors (E. S . Beyn).

All the aforesaid concerning the statistical distribution of different types of paraphasias according to the aphasic forms is of importance for differentiating the state of dynamics of the internal speech processes in patients suffering from various forms of aphasia with different degrees of gravity of the speech disorder.

As to the question of similarity and difference between the main characteristics of the object and action replacements, the following may be pointed out on the basis of data published in the literature concerning object paraphasias (A. Pick, K. Goldstein, M. S. Lebedinsky, E. S. Beyn, I . T. Vlasenko) as well as, on the basis of the present analysis of action paraphasias.

Their similarity mainly consists in the fact that objects and action paraphasias reflect a disturbance of two basic functions of the word: the communicative (an inadequate word) function and the generalizing function (narrowing the meaning of the word), which arises always when the actualization of words is connected with difficulties. In both cases the paraphasias reflect a profound disintegration of the systemic significative structure and functioning of the word which manifests itself in such pathological attributes as disautomatism and non-generalization of the internal operations in the process of word-generation, as well as sliding down to unessentia1 connections and sticking in them. As a result, there arises an inadequate word-name.

A difference in the concrete psychological mechanisms of both classes of word replacements indispensably ensues from the real dissimilarity of the object itself which the patient designates (and thereby generalizes) with the help of the word. A concrete object in one case and an action in the other - each in virtue of its own internal logic - impels the patient to utilize various psychological and linguistic operations when designating (and generalizing) them. In the first case a reflection only of static objects (for example, of a blacksmith or a hammer) is necessary and sufficient, while in the other case a reflection only of objects, being likewise necessary, is still insufficient. In this case a task of a more complex psychological and linguistic level arises before the patient, C

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when a reflection of the objects themselves and of the dynamics of their interaction (the blacksmith forges with the hammer) is required. This is why the significative side of the emergence of action paraphasias (i.e. the operations themselves) differs from that of the object verbal replacements.

Our investigation allows us to draw a general conclusion, according to which an action verbal paraphasia is a convenient model for studying essential aspects of the aphasic syndromes. Thus, action paraphasias of different types reflect the degree and quality of a change (narrowing) in the meaning of words - verbs of aphasie patients. They show that generalized and nongeneralized mental operations implied by the meaning of the words-verbs predominate in their consciousness.

It seems to us that further investigations of action verbal paraphasias in patients with different forms of aphasia are promising and may be useful also for solving definite tasks of restorative speech therapy.

When drawing up programmes for restoring the significant side of speech in aphasias it is necessary to take into consideration the specific features of the structure of internal speech and word meanings which manifest them selve in verbal action paraphasias.

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Documents

Verbal Paraphasias of Aphasic Patients in the Course of Naming Actions