Testing the limits of language production in long-term survivors of major stroke: A psycholinguistic and anatomic study

BACKGROUND: There is still a dearth of information about grammatical aspects of language production in aphasia. AIMS: Making novel use of methods of elicited production aimed at testing the limits of competence, we studied three cases of chronic aphasia, stemming from major stroke. We asked: (1) Whether the elicited production method reveals sparing of language abilities not readily evidenced in spontaneous utterances or on conventional aphasia tests. (2) Which language production abilities survive damage to both Broca's region and Wernicke's region? MATERIALS & PROCEDURES: Targeted words, morphological and syntactic structures were elicited by sentence completion with supporting linguistic and visual context. Targets were never modelled during the procedure. For verbs, visual and auditory contexts emphasise completed actions, targeting past tense forms. Lesion description was based on structural MRI scans. OUTCOMES & RESULTS: The three participants showed partially spared ability to produce nouns, adjectives, and verb stems in context. The elicitation method proved more productive in some cases than picture prompts or sentence prompts. Past tense inflections were usually omitted. Hence stems and inflections were dissociable. Two participants showed partial success with the passive, and no participant produced a full relative clause, including the relative pronoun, but two produced reduced forms of subject relatives. Partial sparing of production capability in these cases points to the likely importance of portions of the left hemisphere remote from Broca and Wernicke regions. CONCLUSIONS: This application of elicited production methodology demonstrates possibilities of lexical, morphological, and syntactic production not evident in spontaneous utterances or by conventional aphasia tests. Some lexical and grammatical capabilities survived massive damage to both anterior and posterior portions of the left hemisphere.