Agrammatism (neurological disorder) - definition, causes and symptoms

Some lesions in the brain can cause this neurological symptom.

The first three years of human life are key for the development and acquisition of speech and language skills. Skills that, in principle, will accompany the person for the rest of his existence.

But there are cases in which this ability is truncated due to lesions in certain regions of the brain; thus appearing aphasic disorders that entail deficits such as agrammatism, of which agrammatism is the most common. such as agrammatism, which will be discussed in this article..

What is agrammatism?

Agrammatism is considered a language disorder typical of aphasias.. Its most notable particularity is that the person presents a linguistic deficit which is shown through failures referred to morphological structures. That is, it presents a great difficulty to join words in a sentence forming syntactically adequate sequences.

This failure usually appears in patients diagnosed with Broca's aphasia. The fact that it manifests as a difficulty in creating syntactic constructions means that it is considered another symptom within this type of aphasia.

However, after the development of cognitive neuropsychology in the mid-20th century, it became clear that agrammatism was something much more complex and that it could be observed in patients who did not meet the other requirements for the classic diagnosis of Broca's aphasia. Moreover, the individual differences between patients were more than remarkable.

At the same time, an immense debate arose as to whether agrammatism could be considered a validated aphasic category. This controversy is still going on today, and there is disagreement between those who advocate for agrammatism as an aphasic syndrome and those who oppose its validity as such.

But what are aphasias?

According to the general definition of aphasia, aphasia refers to a language disorder caused by brain lesions in one of the language areas, rendering the person unable to communicate through speech, writing and even mimicry.

The causes of aphasia can be:

• Stroke
• Traumatic brain injury
• Brain infection
• Neoplasia
• Degenerative process

On the other hand, if we focus on the definition of Broca's aphasia, it is characterized by the practical impossibility of fluent verbal production and the use of short, grammatical sentences produced with enormous effort and in a prosodic manner.

Symptoms

There are a number of symptoms that show up more or less consistently in the comprehension and production of agrammatic patients.

1. Symptoms associated with language production

These are the most frequent symptoms associated with speech.

1.1. Problems in grammatical morphemes

This symptom is reflected in the selective omission of both free and bound grammatical morphemes.. However, this symptom as such is more typical of English-speaking patients, who add inflections to words. But in languages such as Spanish or Italian this is not possible, since inflections are added to roots.

For example, in English you can omit -ed in the word walk, but a Spanish speaker will not be able to omit -ía in comía, since it will no longer constitute a word but a meaningless sound.

In view of this fact, the omission of free grammatical morphemes and the substitution or omission of grammatical morphemes linked according to the language were considered to be characteristic of agrammaticism.

1.2. Average length of sentence utterance

One of the symptoms observed in agrammatism, but not always present, is the reduced length of oral utterance. In which patients express themselves through much shorter than usual utterances and sentences.

1.3. Noun-verb dissociation

Another symptom presented by people with agrammatism is the difficulty in accessing verbal forms. That is, patients omit or nominalize the main verbs of sentences.

This deficit is present both in structured tasks and in spontaneous oral production tasks.

1.4. Difficulties in sentence construction

These patients use subject-verb-object structures; presenting an enormous difficulty in sentences of greater syntactic complexity. This symptom is a consequence of a lexical deficit that affects the correct selection of verbs.

1.5. Problems in word order

This is considered one of the most characteristic features of agrammatism. Agrammatic patients present difficulties in correctly ordering verbal expressions according to an understandable order, especially in the production of passive sentences or sentences with different structures from the usual ones.

2. Symptoms associated with linguistic comprehension

Until the 1970s, agrammatism was considered to be a deficit exclusively in language production, regardless of whether linguistic comprehension was impaired.

However, research on the auditory comprehension of agrammatics has shown that these patients show difficulties in some specific syntactic components, which prevents them from understanding some sentence structures.which prevents them from understanding some sentence structures. It is specified that the alteration is selective since the patients present a great deterioration in the comprehension of certain sentences, but the rest of the syntax remains intact.

Evaluation and diagnosis

Despite the complexity of this deficit, there are no specific tests to evaluate it; the most commonly used tests are those used for the evaluation of aphasia.

Currently, the aphasia subtests the subtests of the Boston and Barcelona tests concerning verbal expression are used: narration of an event and description of an event.The evaluation includes the transcription of the speech and the description of an image. The evaluation includes the transcription of the patient's speech with the consequent evaluation of lexical poverty, the quality of syntagms, the incorrect use of morphemes and lexemes, or the incorporation of functional words.

1. Boston Diagnostic Aphasia Test (Goodlas and Kaplan, 1972).

It is the most widely used test due to its ease of administration. It contains a specific vocabulary assessment test and an abbreviated format for rapid screening of the patient.

2. Barcelona Test (Peña-Casanova, 1990)

This test assesses all cognitive mechanisms related to language. It is characterized by being an extensive and complicated test, but it has an abbreviated format.

Treatment: HELPSS Method

The beginnings of this method were based on certain studies of agrammatism, in which story completion techniques were used in patients with Broca's aphasia and agrammatics.

In addition, this method integrated different levels of difficulty, This method also integrated different levels of difficulty to the story completion activities.. Thus, the HELPSS methodology includes a succession of stages arranged hierarchically in two levels of difficulty: A and B; working, in addition, with eleven types of sentences:

• Imperative transitive
• Imperative intransitive
• Transitive declarative
• Pronominal interrogative
• Transitive declarative
• Declarative intransitive
• Comparative
• Passive
• Direct and indirect object
• Yes/no questions
• Subordinate clauses
• Future

Each sentence type is worked on with both levels of difficulty, presenting twenty stories with different examples of the above sentence types, which are exemplified with images but not with written sentences.

During level A, the practitioner must tell a story that ends with the image of the story. Then a question is posed to the patient in order to obtain from him/her an answer by means of an example. When the person reaches 90% correct on a type of sentence, he/she moves to level B of the sentence.

During Level B, the example sentence is omitted; the patient must elaborate the sentence in a genuine way.