Standard Indonesian agrammatism: Doctoral dissertation's clinical implications (1)

With the present study, we aimed to find characteristics of SI agrammatic speech
and to provide norms that can be used to evaluate deviant speech. Although the
variables were chosen for a study to agrammatism, most of them can be used to
analyze SI aphasic speech in general, including sample from fluent aphasic
speakers. This study is important in that there is no standardized battery yet to
characterize and diagnose agrammatism in Indonesian. What is now available is a
battery for assessing semantic problems in Malay-speakers with aphasia (Jalil,
Liow, and Keng, 2011).

From a communicative perspective, the current data suggest that the core of the
problem of these agrammatic speakers is the omission of obligatory elements of
the sentence. Derived word order does not seem to be a crucial factor. This
suggests that the focus of treatment of the Broca participants who speak
agrammatically, should be on the explicit production of all relevant information.
This can be trained in several ways, but considering that most aphasic patients are
helped more by learning strategies rather than by relearning language skills,
training focused on the pragmatic consequences of certain linguistic constructions
seems most appropriate to improve agrammatic speech in SI. Several of the
variables that have been used in the current study can be used to measure
improvement. For example, Links, Hurkmans and Bastiaanse (2010) showed that
MLU is a valuable measure for improvement. Similarly, McCall, Virata, Linebarger
and Berndt (2010) found improvement on MLU and percentage of grammatical
clauses and Kirmess and Maher (2010) reported an increase of speech rate after
treatment. Thompson, Choy, Holland, and Cole (2010) reported an improvement
on MLU, speech rate and percentage of grammatical sentences after training,
However, when measuring the results of treatment, one should realize that
agrammatic behavior may vary. It is important to do a complete analysis, not only
on the variables that were trained (Bastiaanse, 1995; Bastiaanse, Hurkmans and
Links, 2006; Cameron, Wambaugh, and Shannon, 2010). We know that
improvement on these variables is of crucial importance. Stark showed that
improvement of telegraphic speech results in better communicative abilities in
daily life (Bastiaanse et al., 2006; Links et al., 2010; Stark 2010).
The variables we used are simple to analyze, and, hence, are easy to use for
speech-language therapists and linguists working with SI speakers with Broca’s
aphasia. Since (limited) norms of NBDs are now available, it is possible to do a
spontaneous speech analysis before and after treatment, to evaluate the results.
However, the variables that we included in this study may not be exhaustive for
characterizing agrammatic SI speech. Furthermore, other methods to elicit
agrammatic speech, such as picture description or repetition may reveal deficits
not apparent in the samples analyzed in the current study. Nevertheless, we
realize that what is still needed is an account of what is normal for all possible
subgroups of SI speakers. With SI as a national language and a lingua franca,
education, professional background, gender, and age influence the language
produced. To control for these factors and to make sure that the aphasic speakers
are not evaluated based on the wrong standard, a database of normal production
from all socioeconomic levels is needed.