Abstrak untuk Seminar Nasional Peran Linguistik dalam Ilmu Kesehatan, Sains & Teknologi, dan Sosial Humaniora

Peran Neurolinguistik dalam Penatalaksanaan Ganguan Bahasa setelah Cerebro Vascular Accident (CVA): Karakterisasi Afasia Agramatik pada Penutur Bahasa Indonesia

Setelah Cerebro Vascular Accident (CVA) atau trauma otak seperti stroke dan operasi untuk membuang tumor, bahasa seseorang dapat terganggu. Gangguan ini lazim disebut afasia dan salah satu jenisnya adalah afasia agramatik. Orang-orang dengan afasia agramatik mengalami kesulitan dengan aspek sintaksis bahasa yang digunakannya.

Walaupun penting sekali untuk mengetahui karakterisasi afasia agramatik di Bahasa Indonesia, terutama untuk tenaga kesehatan yang melakasanakan diagnosis dan terapi, kita belum banyak tahu mengenai aspek-aspek mana dari sintaksis yang terganggu. Penelitian Anjarningsih, Haryadi-Soebadi, Gofir dan Bastiaanse (2012) melihat aspek-aspek jenis kalimat, Mean Length of Utterance (MLU) dalam kata, jenis predikat, partikel sintaktik, morfem derivasional dan infleksional pemarkah akusatif, pengulangan, dan urutan kata. Aspek-aspek ini mempunyai potensi untuk mengkarakterisasi ujaran spontan penutur Bahasa Indonesia dengan agramatik afasia. Pembahasannya pada seminar nasional ini diharapkan akan berguna bagi khalayak yang membutuhkannya.

 

Developing education to create clinical linguists in Indonesia

Currently I am in intensive contact with the staff of College of Allied Educators Indonesia. They are pioneering a polytechnic to create professionals working with children with special needs. One of the departments will be applied linguistics/language pathology. There is where I come in. Besides projected to teach in classes in the department, I am also involved in constructing the curriculum.

Professionally and personally, this is an honor. Not long after getting my doctorate degree, I got this offer. While my current employer did nothing upon my return, except for a short presentation I gave in my study program, this other college saw me, my potential, matched that with what they needed, and proposed to hire me. They also welcomed me to join their clinically-oriented courses for free in order to build my clinical skills. After you rushed to finish to PhD in 3 years, published 2 articles, and wrote a long dissertation, you really feel you need to share what you know to people, who obviously need it.

Let's see where this will take me. Teaching and research are my passion and hopefully I can do them both in the near future. Two articles are obviously not many, yet :)

Standard Indonesian agrammatism: Doctoral dissertation's clinical implications (3)

These results have some clinical implications. They can inform therapists why
certain agrammatic speakers had problems in comprehending sentences
containing time reference. In order to make the results more relevant for speech
and language therapists in Indonesia, it is of interest to assess more SI-speaking
agrammatic speakers who differ in the severity of the aphasia. By sampling more
people, the interaction between severity and comprehension problems can be
better captured and generalized. It is also of interest to test SI-speaking aphasic
speakers from various syndromes in a comparative study. By doing this, it can be
observed whether time reference problems in comprehension is similar across
syndromes and if they differ, what are the fundamental differences. Later, valid
and reliable tests and therapy materials should be developed. Considering the
importance of SI for the more than 200 million Indonesians, speech and language
therapies in SI for aphasic stroke-survivors should be based on careful studies and
this study is a pioneer in that respect.

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).

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.

Summary of Harwintha's PhD dissertation

Agrammatic aphasia is a complex of language problems that occurs after damage of the language areas of the brain’s left hemisphere. The areas usually are or include Broca’s area (Brodmann Areas 44 and 45). Generally, agrammatic speakers have problems with grammatical features of language in production and comprehension. In experimental production and spontaneous speech studies of agrammatic speakers of various inflectional languages, such as Dutch, English, German, Greek, and Turkish, time reference has been found to be a weak spot. However, more data are needed to see if the time reference problems are due to difficulties in inflecting the verbs, in referring to a certain time frame (e.g., past), or they are due to some other reasons not yet known.

It is interesting to investigate time reference in Standard Indonesian (SI) for three main reasons. First, time reference in SI is done in two ways, both of which are words or free standing morphemes, not bound like inflectional morphemes. The first way is through the syntactic aspectual adverbs (e.g., sudah, sedang, and akan) and the second by lexical adverbs of time (e.g., baru saja, sekarang). By investigating them, we tease apart the confound of time reference and inflection. Second, related to the first reason, by studying SI we can see if there is a central problem faced by agrammatic speakers when they need to refer to time. In other words, we want to know if the problem arises regardless of how time reference is done linguistically. The third, less related, but not less important reason, is the fact that SI has hardly been studied. Belonging to a different language family than other languages reported so far in aphasiological, neurolinguistic, or psycholinguistic literature and having a large number of speakers make SI a language that can contribute considerably to the field(s).

The work discussed here is a part of the cross-linguistic study on time reference in the Neurolinguistics group in Groningen. Apart from looking to time reference in SI, we also evaluated the test battery which is also used in more than fifteen languages. Thus, our results also informed this large scale study as to whether the test is valid to be used for investigating time reference in SI.

Chapter 1 gives background information about SI that is needed to understand the following chapters. Some theoretical accounts related to time reference in agrammatic aphasia were presented, two of which were chosen to be tested in the current project. Four general research questions were formulated at the end of this chapter.

Will the Standard Indonesian (SI) aspectual adverbs be difficult for the agrammatic speakers?

The weak syntax model predicts that they should be difficult because they are discourse-linked. Meanwhile, the PADILIH predicts that only the perfektif aspectual adverbs will be difficult.

Will the lexical adverbs be difficult for the agrammatic speakers? 

Classically, these adverbs have never been documented as impaired in the literature. However, the fact that they are used to refer to time and are discourse-linked predicts that they can be difficult for the SI agrammatic speakers.

Are the difficulties caused by these two kinds of adverbs similar or different? 

If they are different, are the differences related to the modality (spontaneous speech, comprehension, and production)?

 

Chapter 2 aims to characterize agrammatic speech in SI because there was no test or method to screen SI-speaking participants with agrammatic aphasia who could participate in our time reference studies. Based on some variables that have been widely published in the literature and some variables that are unique to Standard Indonesian, we concluded that SI agrammatic speech is characterized by short and syntactically simple sentences, slow speech rate, low proportion of particles in general and syntactic particles in particular, problems in realizing grammatical objects after accusative markers, possible problems with derivational affixes and reduplication, and no problems with verbal predicates and derived word order (passives). The participants of this study, who had agrammatic speech, participated in the time reference studies discussed in chapters 3, 4, and 5. 

In chapter 3, the study investigating the relationship between the diversity of verbal predicates (as measured by Type Token Ratio) and the aspectual adverbs produced with the verbal predicates is presented. When the performance of the agrammatic participants was compared among one another, the results showed a trade-off between the two variables. On the one hand, the agrammatic speakers who had higher Type Token Ratios produced aspectual adverbs less frequently.  On the other hand, the agrammatic participants who had lower Type Token Ratio produced aspectual adverbs more frequently. The agrammatic speakers who produced aspectual adverbs less frequently did not overuse lexical adverbs to compensate. Therefore, research question number 1 can be answered affirmatively (the SI aspectual adverbs are difficult) and there is a trade-off between the diversity of verbal predicates (as measured by Type Token Ratio) and the percentage of aspectual adverbs produced with the verbal predicates, without an overproduction of lexical adverbs of time to compensate the need to refer to time.

The dissertation continues to chapter 4 which presents the comprehension study. The non-brain-damaged (NBD) participants performed at ceiling in the TART comprehension test. The agrammatic participants performed significantly worse than the NBDs at the group level in both the aspectual adverbs and lexical adverbs of time tasks. At the individual level, five agrammatic participants scored significantly worse than the NBDs in both tasks. For the scores of the agrammatic participants, there was a strong correlation between the scores on both tasks. In other words, they were similarly impaired in understanding sentences containing aspectual adverbs and sentences containing lexical adverbs of time. At both levels and both tasks, no time frame was selectively impaired. We attributed this to the fact that in SI the use of the adverbs is optional and these adverbs are used when context does not provide enough time reference information. Therefore, all the adverbs are equally vulnerable in comprehension. Based on these results, we can answer research questions 1 and 2. In comprehension, the time reference problems affect both ways of referring to time and there was no statistically attested difference posed by the aspectual adverbs and lexical adverbs of time. 

The production study is presented in chapter 5. With this study, we wanted to answer all four questions, especially regarding the comparison with the results of the comprehension study. Here, the results showed that the agrammatic participants also had problems producing sentences containing aspectual adverbs and lexical adverbs of time. In production, there seemed to be a qualitative difference between the two kinds of adverbs that made the lexical adverbs more susceptible to be substituted by aspectual adverbs than the other way around. We suggested that this was because of the referentiality of the lexical adverbs of time which made the agrammatic participants integrate between linguistic level and context. The non-referentiality of the aspectual adverbs did not necessitate this integration. However, since the NBDs did not perform at ceiling, suggesting that the production test is not the optimal means for SI, we did not draw further conclusions.

Chapter 6 presents a comparison across the four studies discussed in the previous chapters. Five agrammatic participants participated in the three time reference studies and three of them were impaired in all those studies. This means that these five agrammatic participants showed the trade-off in chapter 3, but only 3 were impaired in comprehension and production. 

In chapter 7 the results were discussed in relation to the literature and some suggestions for adaptation of the two theories were suggested. 

There is a selective difficulty in referring to the past when time reference is obligatorily marked (e.g., in English, Dutch).

2. Referring to the past is not selectively difficult when time reference is optionally realized and is used to link the event to discourse.

3. In the case of optional time reference markers, the markers that need more integration with discourse level representations will be more impaired than the markers that require less of this, at least in production. 

This revision needs to be tested in other languages. In the interest to advance knowledge in aphasiology and to inform aphasia therapy, we believe our results encourage more research to be carried out in Standard Indonesian, other dialects of Indonesian, and other Austronesian languages.

A recipe for a well-done PhD project

2 spoonfuls of ignorance to small stuff (e.g., gossips among senior researchers about themselves), 4 cups of good day-to-day planning, and 100 ml of optimism. Mix them together well and add 3 spoonfuls of life outside the office and 200 ml of good daily communication with family. Bake the dough on medium-sized flame for at least three and a half years years.