Introduction

The following exercise is a case study of a woman (‘HW’) who was studied by Bastiaanse (Reference Bastiaanse1995). HW developed Broca's aphasia following a cerebrovascular accident (stroke) in August 1986. Aphasia is a common post-stroke sequela, which has been reported to occur in 30% of patients with first-ever ischaemic stroke (Engelter et al., Reference Engelter, Gostynski, Papa, Frei, Born, Ajdacic-Gross, Gutzwiller and Lyrer2006) and 34.8% of sub-acute stroke patients (Hoffmann and Chen, Reference Hoffmann and Chen2013). Broca's aphasia is the most common subtype, accounting for 27.2% of all aphasias in a large, sub-acute stroke population (Hoffmann and Chen, Reference Hoffmann and Chen2013). The case study is presented in five sections: history and initial assessment; assessment 15 months post-onset: part 1; assessment 15 months post-onset: part 2; focus on spontaneous speech: part 1; and focus on spontaneous speech: part 2.

History and initial assessment

HW is a right-handed woman and native speaker of Dutch. She is married and has two children, a 15-year-old son and a 12-year-old daughter. Prior to her stroke, HW did cleaning two mornings a week and was a ‘reading mother’ at a primary school. Her hobbies were reading, needlework and fishing. With the exception of a hearing impairment on the left side, HW was healthy prior to her stroke.

In August 1986, HW experienced sudden paralysis on the right side. She was aphasic and was hospitalised in an unconscious state. Upon regaining consciousness, HW was unable to speak. Her right limbs were paralysed and her vision was also impaired. A CT scan was conducted two weeks post-onset. It revealed an ischaemic infarct in parts of the temporal and frontal lobes, with damage extending to the left parietal lobe. At one month post-onset, HW was discharged from hospital and admitted to a rehabilitation centre. Her right arm was still not functional. However, the paresis of her right leg had decreased with the result that she was able to walk using a delta-stick.

At four months post-onset, HW underwent linguistic and neuropsychological assessment as an inpatient of the rehabilitation centre. It revealed that HW was suffering from a typical Broca's aphasia. HW displayed relatively intact comprehension of spoken language – her score on the Token Test was 56/61. Neuropsychological assessment revealed that HW had poor verbal memory due to retrieval deficiencies – she had a percentile score of 50 compared to aphasics. HW scored in the 7th decile compared to other aphasics on the Raven Coloured Progressive Matrices. No other neuropsychological deficits were found. In an attempt to improve HW's language abilities and help both her and her family cope with her aphasia, HW received speech therapy five times a week. Her language therapy focused on sentence construction, writing and text comprehension, using a programme for training sentence construction. HW also received physiotherapy, occupational therapy and the assistance of a social worker.

Assessment 15 months post-onset: part 1

At 15 months post-onset, a further assessment of HW's linguistic and neuropsychological abilities was performed. A percentile score of 100 was obtained on a verbal memory test. HW had a score comparable to an IQ of 110 on the Raven Standard matrix. Comprehension of nouns was intact at the previous assessment and was not examined again. Comprehension of verbs was assessed using a test in which HW had to select one of four action pictures. Alongside the correct picture, there are three semantically related distractors. HW displayed 100% correct performance on this assessment. A Dutch version of the Test for Reception of Grammar (TROG; Bishop, Reference Bishop1983) was used to assess HW's auditory comprehension of sentences. There were only two errors committed on this test. One error concerned the single–plural distinction of nouns, while the other error involved an embedded sentence. HW got 28 of the 30 items on the Token Test correct. Spontaneous speech was analysed and will be considered in units 25.4 and 25.5. HW named all 40 items correctly on the Dutch version of the Boston Naming Test (Kaplan et al., Reference Kaplan, Goodglass and Weintraub1983). HW's ability to retrieve low-frequency words was assessed using the Graded Naming Test (McKenna and Warrington, Reference McKenna and Warrington1983). HW named 15 of 30 items correctly, a score which is comparable to that of normal controls. Errors included circumlocutions and wrong interpretations of the picture. In a test of naming actions, HW named 37 out of 40 actions correctly. She used the infinitive form of verbs to name the actions. The three verbs which she could not name were: to carpenter (HW: to strike the nail into the plank), to moor (HW: to hang the boat on the hook) and to dig (HW: the man polders, the man shovels out the land, shovels hole).

Assessment 15 months post-onset: part 2

The repetition of single words and sentences was also assessed at 15 months post-onset. HW's repetition of words was intact. There was a slight impairment of sentence repetition, particularly in longer sentences. For example, when asked to repeat In the classroom all children were talking aloud, HW said ‘In the classroom all children talk loud’. To test sentence construction, a sentence anagram test and a subtest of the Aachen Aphasie Test (Graetz et al., Reference Graetz, De Bleser and Willmes1992) were used. The anagram test was performed with little difficulty. In the Aachen Aphasie Test, the items used and HW's responses were as follows:

Focus on spontaneous speech: part 1

At 15 months post-onset, an assessment of HW's spontaneous speech was also conducted. Extracts of HW's spontaneous speech will be examined in detail in units 25.4 and 25.5. In the extract below, the interviewer (INT) and HW are discussing HW's language problems

Focus on spontaneous speech: part 2

In this lengthier extract, also recorded at 15 months post-onset, the interviewer and HW are discussing Christmas and HW's new house.