Standard Indonesian agrammatism: Doctoral dissertation's clinical implications (2)

The main conclusion of the current study is that agrammatic speakers who focus
on lexical information (the verb) do so at the cost of information about the time
frame in which the event takes place, and vice versa.We do not suggest that this
focus is a conscious choice, or that the focus of agrammatic speakers is static.
Bastiaanse (1995), for example, described a woman with agrammatic Broca’s
aphasia who was interviewed about her speech problems and produced a normal
proportion of finite verbs, but the lexical verbs had a low diversity. When the
interview topic switched to the description of her house, she switched to typical
agrammatic speech: the verb diversity increased but the verbs were no longer
inflected as regularly. When she was asked whether she was aware of this switch,
she said she was not. It was obvious that the change of register was unconscious.
From a clinical point of view this is an interesting phenomenon: when the patient
focused on the use of lexical verbs she was much more comprehensible and she
provided much more information. Such variability within aphasic speakers has
been observed more often (Cameron, Wambaugh, and Shannon, 2010). This
implies that focus on the appropriate use of verbs is better than focus on verb
inflection from a communicative point of view. The current study suggests that it
is the expression of the time of the event in combination with the verb is the core
of the problem, rather than verb inflection.

In aphasia therapy, especially in treatment of agrammatic aphasia, the focus is
often on the production of correct and complete sentences. However, considering
the relationship between verb retrieval and specifying the time frame by verb
inflection or aspectual adverbs, speech-language therapists should be very careful
that successful training of correct and complete sentences does not come at the
cost of verb diversity (see Bastiaanse, Hurkmans, & Links, 2006; Links, Hurkmans,
& Bastiaanse, 2010). Rather, speech therapy should focus on the use of lexical
verbs, specifically on the use of a variety of lexical verbs. These are very important
for communication in daily life.

A successful therapy in this respect can be decided after a certain baseline
performance is obtained and is sustained in a certain period of time. Afterwards,
further therapy is conducted which focuses on the production of aspectual
adverbs. An important example of such a therapy is provided by Wieczorek,
Huber, and Darkow (2011) who used a computer program to train the production
of aspectual information. Finally, we think it is appropriate to inform to the
agrammatic speakers about their deficit and to train them to cope with it in an
optimal way. Therefore it should be explicitly mentioned to the agrammatic
speakers that they should focus on verbs and not on grammatical sentences, and
therapy should be adapted to this (see Ruiter, Kolk, and Rietveld, 2010; Springer,
Huber, Schlenck, and Schlenck, 2000).