the aphasiology of a.r. luria

J. Neurolin@~rics, Volume 4, Number I, pp. 1-18. 1989. 091 l-6044189 $3.00 + .OO Printed in Great Britain 0 1989 Pergamon Press plc

The Aphasiology of A. R. Luria

Lluis Barraquer-Bordasi

Autonomous University of Barcelona

ABSTRACT

Luria’s aphasiology and its features are presented. The author introduces some

considerations concerning relations and contrasts of Luria’s view and those of other

outstanding aphasiologists.

INTRODUCTION

In the second half of the last century and long before being termed as such,

aphasiology began to be used in clinical and pathological methodology and

contributed to its development.

After the Second World War, while not abandoning interest in the distribution

and topography of lesions that result in different clinical pictures of aphasia,

descriptions were directed along other lines. For example, emphasis was placed on

the dichotomies: fluency/ non-fluency, conservation of repetition (although this

obviously cannot be considered a particular “function”)/affecting of repetition.

Above all, linguistics was applied in a greater degree to aphasiology, mainly with

respect to the contraposition between the ability of syntagmatic combination and

paradigmatic choice. Chomsky’s ideas with respect to performance/ competency

and the distinction between superficial and deep structures were also explored.

Luria’s aphasiology is a modern contribution; generally, it is distinguished from

the norms by its own semiological descriptions and an attempt at its own

classification of the different types of aphasia, types that Luria himself outlined

with more or less precision and that do not correspond to those generally accepted.

Luria tried to “overcome” the classical phenomenological descriptions of

2 Journal of Neurolinguistics, Volume 4, Number 1 (1989)

aphasias and searched for partialfbctors that resulted in different basic types. rhis

author conceived three stages of aphasiology.

(a) The first “localizationistic” stage, based on the fact that the description ofthe

supposed basic clinical types was often accompanied by the attempt to find a

limited localization of the language processes in the surrounding cerebral arcas.

Until a few years ago, most of the descriptions of aphasias (although one cannot

ignore the “dynamic” currents characterized by much more “overt” signs, first

described by Jackson) were kept, if not in this strict field. at least within the

branches that more or less arose from it.

(b) The second “neuropsychological” stage, in search of the,fhcror.v iniria/!t,a/trr&

as a result of the focal lesions. This is an attempt to understand the basic

mechanisms of language.

(c) A third ~‘~~urodynam~c” stage, in the Pavlovian sense, with the idea of

understanding the basic symptoms of aphasias in terms of prrrliuf cl7atzg~j.r of this

lineage. In this field, Luria refers to two problems: (i) clisordcrs ofthe “ruk O#

jiww “, in the regulation of cortical functions, in which case weak stimulations

would determine reactions as much as or stronger than intense or large stimu-

lations: in this manner the “highly- selective nlu~tidimensional matrix”. which

constitutes language. would be impaired. This would result in the appearance of

“matrices of contextual associations”. origin of verbal paraphasias. Such disorders

would appear to electively affect thel,ostPriorpurt.v of the“language areas”: and (ii)

lust 01’ irort>rul “neural plasticit_\,“, with the appearance of “pcrtholo~~ic~al inertia”,

expressed in the language sphere by the appearance of perseverations; this would

occur partjculariy in the cases where the lesions involve the unterior purrs of the

“language areas”.

Luria placed his own contributions within the scope of neuropsychology.

estimating that the analysis of hasic,fuctor.s that support the different types of’

language disorders signified an important step in the development of aphasiolopy.

He considered the development of the analysis of “neurodynamic” mechanisms as a

new step that had just been undertaken.

On the basis of his analysis of “partial factors” that would result in the different

“basic types” of aphasia, Luria distinguished and discussed these types in detail in

the following manner.

Aeousijc~-A~nosic or Sensorial Aphasia as a Result of Posterior Temporal Lesions

Luria derived this form of aphasia from theabsence of a well-defined function or

linguistic component. the phonological component. In order to construct the

sounds of speech -.- and to understand them -- Luria and Hutton (1977) empha-

sized that we must be able to qualify sounds: stated otherwise, we must include

sounds in systems of phonemes, basic units of speech. “This qualification is done by

The Aphasiology of A.R. Luria 3

the secondary zones of the auditory cortex, particularly the region termed Wer-

nicke’s area.” Consequently, the basic defect that appears in this region is the luck of

differentiation of the phonemes. This is not an auditory defect, as Wernicke

supposed, nor an intellectual defect, as Marie (1926) implied, but rather “the ability

to convert elementary sounds into complex sounds, phonemically organized, is

affected.” This phonemic organization varies from one language to another and,

for example, characteristics such as “hard” and “soft” or “low” and “loud”, which

are pertinent to one of them, lack a differential value for many others. As a

consequence of this fundamental lack, patients with acoustic-agnosic aphasia

would be incapable qf distinguishing between ver]’ similar “oppositional” and

“correlational”phonemes that differ in onlv one characteristic (for example, they

repeat “bapa” as “ba-ba” or “pa-pa”). These disorders are characteristic of a lesion

of the secondary (auditory) zone of the temporal lobe and adjacent zones. This

modal (acoustic) disorder of systematic hearing (limited to the language sphere)

“must cause a dissociation of sounds and meariings of words, which is basic in the

sensorial aphasic syndrome”. Luria himself underlined the words and this permits us to see how the author recognized the break between the semiological level and

the semantic level of the linguistic sign that occurs in this type of aphasia, thus

approaching - perhaps more than apparent ~ the position of the school of

Alajouanine (1968) among disorders of verbal comprehension. It alone would be

genetically, Luria makes the whole defect depend on the disorder of phonemic

anaf.vsis, that is, on the first of the three physiopathological levels described by

Alajouanine (1968); among disorders of verbal comprehension. It alone would be

responsible for the final “attack” on the significance of the words.

Word repetition is seriously affected. Spontaneous language is deprived qf

substantives and can adopt the form of a “salad of words”, in which phonemic

paraphasias appear, even though the patient is able to make himself understood

because of intonation, rhythm, etc. But there exists, for the reason we just

described, an “alienation of the significance of words”. The fact of an amnesic

aspect that the patient shows in searching for a word does not improve by giving

the observer the oral outline of it.

In the “rare” cases of true verbal deafness, the disorder of phonemic hearing

would occur separately.

In more posterior temporal lesions, there is a disturbance of nominativefunction

of language, connected with an inability to evoke visual images as f~ response to a

given word. The patient presents acknowledged difficulties in drawing the figure of

the named object.

Although recognizing the presence and importance of the disorder in discrimi-

nating phonemes, which Luria emphasized so much, Blumstein et al. (1976)

concluded their analysis of phonological factors in disorders of comprehension in

4 Journal of Neurolinguistics, Volume 4, Number I (1989)

different types of aphasia, by judging that a dejtict in phonemic hearing curlnot

ucccwnt .for the comprehension disorder ,found in Wernicke’s aphasia.

Acoustic-Amnesic Aphasia

Acoustic -amnesic aphasia resulting from medioten~pora//esion.s. is located in the

centre of the temporal gyrus or in the back of the temporal lobe. The defect would

take on the form of an alteration qf audio~~erhal memor.,’ or distinct awustic

umnesic, alterations. The patient cannot retain a short series of sounds. syllables or

words in his memory; he confuses elements in the series or some elements disappear

from his memory, which implies a d<fec,t in retention qfpermanent audiolir7,~ui.~tic,

recordings. This defect has a modally specific (auditory) character. It is based,

according to Luria, on an increasing mutual inhibition of auditory signals that

leads to a peculiar reduction in the order qf successive uwustic, perception. If the

intervals between elements in the series are longer, this inhibitory effect decreases:

each stimulus is better consolidated and retention is better. There is no “alienation

of the significance of the word”. There is a “disappearance” of the acoustic structure

01’ the words.

Semantic Aphasia

According to Luria, semantic uphasia originates from a disturhunc,e, at the level

of s~~mholic simultaneous s.vnthesis (“quasi-spatial”), dependent on a lesion c$thr

supramodal third parietal injtirior zone (angular gyrus and supramarginal gyrus,

areas 39 and 40 of Brodmann) or, more broadly. the parieto-temporo-occipital

zone. This region is very characteristic of the human brain and it does not become

morphologically mature until about age 7. The patient presents amnesic l,erhu/

d+cts in the strictest sense, that improve when the oral outline of the word i\

offered. For Luria, the “dynamic disturbances of the law of force” of the local

cortical function (in the Pavlovian sense) that occur in such lesions can lead to an

equally probable multitude of possibilities of association, either of the phonetic

nature (we would have to say phonological to keep to thedifferentiation of Lecours

and Lhermitte (1976)), morphological nature or semantic nature, from which

emerge all types of’paraphasias (phonemic and nominal, of the morphological or

semantic type). The difficulty in finding words is mainly- concentrated in the

designation of objects (substantives) and less in that of qualities (adjectivea) and

actions (verbs). What would be altered would be the designation of conc~rete

objects. not the abstract category. This would be related to the d$ficulties that such

patients show in carrying out the visual representations of the corresponding

objects (Tsvetkova 1977). Such patients, although thqv under.ftand the.rignifi’c,clnc,r

of the individual r<-ords, cannot understand the significance ofthe constrwtion a.? (I


whole. They cannot appreciate the significance.of the logicogrammatical relation-

ships. They can understand the “communication of events”, but not that of

“relationships” (in the terminology of Svedelius). A typical example is given by the

structure of the attributive genitive case (they cannot distinguish between “the

brother of the father” and “the father of the brother” or “the cross is under the

triangle” and “the triangle is under the cross”) which, in contrast to simpler

constructions, such as the partitive (“piece of bread”), “cannot be visualized in

concrete terms, but they express certain abstract relationships”(an idea that Luria

proposed and even underlined). Nor do they understand sentences such as:

“Tatiana is darker than Sonia, but blonder than Katherine.” The patient presents a

kind of “receptive agrammatism,” at least in a certain dimension. In this manner,

the comprehension of syntagmas offering a definite structuration is electively lost,

which expresses the disintegration of certain semantic schemes. The picture is

associated with a disturbance in arithmetic ability, constructive apraxia, etc.

Two very characteristic features of Luria’s ideas are the following.

(a) On the one hand, he places the break in simultaneous synthesis, implicated as

a primary factor in this type of aphasia, in the line of disorders with a “yuasi-

spatial” basis. “It is well known,” stated the author, “that lesions of the inferior part

of the left parietal zone inevitably results in disorders of orientation and space,

which are associated with serious defects in calculation and an inability to

understand complex logico-grammatical constructions.” Here, Luria wants to refer

to the existence of disorders within the “interior psychological space”, which would

prevent the capture of “quasi-spatial” relationships implicated in sentences such as

those previously referred to. Lesions of the inferior parts of the left parietal zones.

in eliminating the factor of simultaneous spatial synthesis, result in - states Luria

- a disorder of these complicated forms of verbal behaviour.

(b) The other great feature of Luria’s ideas that we want to mention here refers to

the declared opposition between the serial and sequential disorder, which depends

on lesions of the premotor cortex and simultaneously, concurrently, the “quasi-

spatial” disorder, resulting from inferior parietal or parieto-occipito-temporal

lesions. Jakobson (I 964) picked up this opposition formulated by Luria and placed

it as one of his three basic dichotomies in the estimation of different types of

aphasia.

The symptoms accompanying semantic aphasia would reflect the same disorder of “simultaneous synthesis”. Hence, disorders in spatial orientation, constructive

apraxia and acalculia.

Hier et al. (1980) studied three cases of semantic aphasia, basically adhering to

Luria’s ideas. For two patients, the CAT revealed infarcts at the left parieto-


occipital junction and the third patient presented bilateral haemorrhagic lesions at

the temporo-parieto-occipital junction. The three patients also presented construc-

tive apraxia and elements of Gerstmann’s syndrome. The authors suggested that

“the aphasic as well as spatial disorder of patients with semantic aphasia can be

manifestations of a common defect in the perception of spatial relationships,

produced by a lesion in the left temporo-parieto-occipital region.” Apart from the

fact that the inclusion of the temporal topographic component can be unnecessary,

we want to personally emphasize that as much as the disorder defined as semantic in

such cases has a “parallelism” to the spatial and, even though its “analogous

structure” is found, so to speak, in other situations, the semantic level of language

(that of meanings), is affected in itself. To explore this would imply. among other

things, raising the idea of aphasia defined as “semantic” (\ji& irr!ru).

Lhermitte et al. (1976), Melice-Ledent et ul. (1976) and Gainotti e/ (I/. (I 983) have

been concerned, in one way or another. with this.

Afferent or Apraxic Motor Aphasia

A.fjivent or apraxic motor aphasia depends on an q~fi~t-tmt altrration of the

movements qf the speech apparatus, caused by a lesion oj’the rolandiic~ operculrrm

and the ir$v?or parts qf the post-rolandk area. Such a loss of precise oral

movements eliminates one of the physiological requirements for correct verbal

expression. The basic disorder would originate in a~~ositionalapruxia c;f’thespeech

organs in the search for suitable articular movements for the different sounds

(articular schemes qf “articulernes”: ” basic units of motor language”).

In the most severe cases, the patient cannot find a single combination of the

necessary movements for the pronunciation of the proper sound. In the mild cases,

the substitutions begin to take on a more concrete form. confusing, for example,

labial sounds (“b” for “p” or for “m”). The writing is also affected, as the graphemes

for which articulation is similar, are substituted one for the other.

Lecours (1980) stated that he had never observed a iesion limited t(J the left

ascending parietal gyrus, which undoubtedly leads to a v’ery cautious attitude

towards the anatomo-physio-clinical idea that Luria postulated for the aphasia he

defined as afferent motor or kinesthetic. Nevertheless, Lhermitte pt u/. (1980)

described a kinesthetic motor aphasia syndrome associated with a “pseudo-

thalamic” sensitive defect syndrome resulting from a partial left superficial .silvian

infarct, revealed by a CAT. Neurolinguistic study of this case revealed that the

patient had a disorder of oral productions characterized by a high incidence of the

substitutions of articulation. differentiated from the arthric disorders, as well as the

phonemic jargon. They conclude that “kinesthetic aphasia would be differentiated

by this clinical specificity and by the site of the lesion: anterior parietai lesion of the

The Aphasiology of A.R. Lurk 7

dominant hemisphere”. But they cannot define or even approximate the frequency

with which it occurs.

Luria recalled the positions of Marie (1926) (anarthria), Alajouanine et al. ( 1939)

(syndrome of phonetic disintegration), and Bay (1964) (cortical dysarthria),

“approximating” them to his kinesthetic motor aphasia, although he defined the

basic defect as “apraxic”, a “reduction” that Alajouanine and Lhermitte (I 960) did

not accept. For the rest, the lesions causing a syndrome of phonetic disintegration

were identified in the inferior portion of the ascending frontal gyrus or in the second

frontal gyrus (Lecours and Lhermitte 1976; Puel cf al. 1984).

Efferent Motor Aphasia

Efferent motor aphasia is a consequence of the disorders of motility that,

according to Luria, are created by lesions of thepre-motor zone, relapsing in such a

case concretely in the sphere of motility that intervenes in oral expression. There is

an inertia of the “articulemes”. The patient loses the ability to pass without a

solution of continuity from one articular position to another.

Pronunciation of sounds in serial combination is severely affected. The dynamic

aspect of the verbal activity, the fluidity, is lost. There are perseverations. But the

ability to pronounce “pure” sounds in individual form is retained. The essential

elements of this form of aphasia are the loss of the serial or sequential organization

of language, a result of the pathologic inertia of the individual articular impulses,

and the disorder of the interior language that develops after the acute clinical

picture, in subsequent states, is connected with motor agrammatism. Trying to

repeat sentences, the patient is only able to reproduce some words, usua/l~

substantives. His spontaneous language is transformed into an enumeration of

objects, but in spite of this, he cannot express a thought in the.form of aproposition.

He has lost the predicative significance of’ wlords.

These last aspects of the description that Luria presents of his “efferent motor

aphasia” inevitably remind us of Pribram’s (1971) idea with respect to “predi-

cation”, as a basis of the “productivity” (Jakobson 1964) of language.

In his book, Fundamentos de Neurolingiiistica (Fundamentals of Neurolinguis-

tics), Luria (1980) places and studies separately the disorders of the syntagmatic

organization of verbal codification, in patients with “telegraphic style”, from those

with complex forms of “efferent motor aphasia”, which implies separating, at least

up to a certain point, the agrammatism of “Broca’s aphasia”.

Luria states that in cases of lesions of the inferior zones of the pre-motor area, the

disturbance in codification of expression acquires a different, more specific charac-

ter, compared to that observed in “dynamic aphasia”. The main component

involved in this case is the predicative structure of expression, while its denomina-

tive components remain intact. If such a disturbance is severe, a “telegraphic style”

8 Journal of Neur~li~guistjes, Votume 4, Number 1 (1989)

results, in which the predicative structure of coherent speech disintegrates and

speech, as a whole, consists of only “nominative” components.

According to Luria, in the less severe cases or in some states of regression, the

“telegraphic style” is replaced by a lesser form ofagrammatism, in which the simple

forms of predicative organization of expression (such as the simple subject-predi-

cate struture) are made possible, while the more complex structures (for example,

the complex subordinated intercalates) and the observation of rules of agreement,

etc., are affected.

Finally, Luria states that there is a “third group ofcases”(and the third is between

quotation marks, to separate it from dynamic aphasia and “telegraphic style”), with

a clinical picture of efferent motor aphasia, jt.irh disorder of’rlrc kinetic t~ekmf~~ c!f

\tvrds andpathoiogic inertia. This last factor, probably related .-- he states --- to

deep lesion foci in the anterior zones of language. is not in itself a speech defect, but

it makes this disorder more severe and results in the complete inability to produce

coherent speech, which requires the possibility of fluid steps from one element to

another of oral expression. “Such defects;” Luria emphasires. “constitute the main

characteristic of the form of aphasia usually known as Broca’s aphasia,” It 15

important to recognize Luria’s point of view regarding the importance that

“pathologic inertia” would have in this “very classic” form of aphasia (it would be

connected, in a certain manner, to the loss of fluidity of oral expression) as well as in

the anatomo-clinical field, the value given, in the appearance of this inertia, to the

“severe” or “penetrating” character of the lesion. Let us remember here that

Hecaen and Consoli (1973) were able to find very different characteristics in their

patients with lesions in Broca’s area; they were superficial. deep or penetrating.

Dynamic Aphasia

Dynamic aphasia occurs, generally, as a result of lesions y$‘the ir@+iorpar-rs q/

thefkontal lohe, anterior to Broca’s area. Its distinguishing characteristic is that

even though the ability to utter words and repeat sentences remains intact, the

patient finds himself completell.lackingspontaneorts language and very rarely does

he use it to communicate. The involvement of different parts of the premotor zone

of the more anterior frontal cortex gives different nuances to the clinical picture. In

dynamic aphasia, there are no disorders: (i) of the external organization, either

auditory (as in sensorial aphasia) or motor (as in the two variants of this, which

Luria distinguishes); or (ii) of the internal, logico-grammatical organization (as in

the case of semantic aphasia), all these sectors of language remaining intact. But

there is a loss of the spontaneity, ~~Ianguage, to use an expression of Kleist’s ( i 934)

to characterize the disorder of his frontal patients. Luria extracts the defect that

dynamic aphasia expresses from a stage of “interior language”. “preliminary

scheme” of a “theme”, which must be verbally expressed. Remember that for

The Aphasioiogy of A.R. Luria 9

Vygotski (1962) this necessary stage of interior language has a predicative function.

Therefore, one might state that, generally, the “predication” would be compro-

mised, although at different levels, in both dynamic aphasia and efferent motor

aphasia.

This type of disorder usually becomes evident when the patient is questioned; the

questions initiate an echolalic repetition. If, on the other hand, he is asked to givea

long narration, he only gives brief, simplified, elementary responses. This is more

evident in writing, although writing by dictation remains intact. The loss of the

ability to narrate is characteristic.

In one of his works. Luria expressed himself as follows: “. . . in cases of severe

lesions of the frontal lobes, the patient is unable to express his intentions and

thoughts. either in the verbal or written forms”. “I will never forget,” stated the

author, “a letter written by a woman who had a severe lesion in the frontal lobe. to

the famous neurosurgeon, Professor Burdenko. ‘Dear Professor,‘she wrote, ‘I want

to tell you that I want to tell you that I want to tell you that I want to tell you.. .‘.

and she filled four pages of the letter without taking another step!”

Commenting on dynamic aphasia, Jakobson (1963) emphasized that the ability

for monologue is selectively lost in this disorder.

As we just mentioned, according to Luria, the basic element of this aphasia, at

least for the most part, would be a disorder of the interior language. “In some of

those cases,” as written in F#~d~~e~r~s de ~eur~~jng~isfica (Luria 1980), “repeti-

tive coherent speech remains intact. but, as a consequence of the disorders of the

‘interior language’ and the formation of ‘deep syntactic structures’, the active

creation of what many authors define as ‘linear scheme of the sentence’ becomes

impossible and the patient is unable to formulate a spontaneous expression or

convert his thought in developed speech.”

It is very interesting to note the reference Luria makes, as we saw previously, of

the presence of echolalia in his “dynamic aphasia”, as it raises the problem of

“approximation” between it and the classical “transcortical motor aphasia”.

In Jakobson’s (1963) view, dynamic aphasia can be considered as a definite form

of destructuration of contextual language, respecting its basic code relatively well.

Luria described the localization of lesions producing dynamic aphasia, and

implicated a disorder of the posterior frontal and premotor zones of the kft

hemisphere.

For Luria, his dynamic aphasia “is identical”, in part, with the form of aphasia

described by Head (1926) as “verbal aphasia”. But other authors compared,

instead, the latter with Broca’s aphasia of the “classics”.

With respect to the idea of dynamic aphasia, if one wants to characterize it by a

loss of monologue with dialogue remaining intact, it can be placed in the study

carried out by Ramier and Hecaen (1970) regarding the defects of verbalfluenc?~.


This defect is particularly evident in left frontal lesions (Miller. Benton), but it also

appears, although to a lesser degree, in the right frontal lesions and appears to

depend (according to Ramier and HCcaen (1970)) on the interaction of two factors:

the loss of the incitement to action, connected with ,frontal lesion. and lqft

laferalization, by hemispheric “dominance”. The defect is analyzed by asking the

patient to give, in a determined amount of time, the most possible number of words

starting with certain letters and placing certain restrictions(no proper names, etc.).

There is a relationship with disorders defined by frontal lesions located in front of

“Broca’s area”: loss of spontaneity of language, etc.

Tissot (1966) believed that the form Luria defined as “semantic”is very similar to

that which Head (1926) defined in the same manner, and heconsideredthat in both

cases this tkfinition \t’as inadequate; “unfortunate”, he stated. The nominal

aphasia of Head (1926), “in the linguistic sense,” stated Tissot, “should be

classified as semantic.” For the same reason, it should not be what Head so termed.

as in its content it is similar to what Luria resorted to giving the same definition.

Therefore, according to Tissot (1966), the expression “semantic” would not be

justified either in Iuria’s recent descriptions or the older ones of Head. “Indeed.”

stated this author. “for the patients with this disorder, the separate words have not

lost their significance: rather their arrangement in the speech chain, their reciprocal

relationships. as well as the indication of their relationships with functional

monemes. their subordination. and coordination, are no longer grasped.“Spcaking

properly, this disturbance could not be defined as semantic except in the measur-e in

which the meaning of most of the words is determined partly by the context in

which they appear. The current genesis of the concept through the context would be

compromised in this form of aphasia. But the basic disorder would be based on the

disturbance of the system of relationships between the different signs of what is

stated. “We find it difficult,” stated T&sot (1966), “to find an univocal linguistic

explanation.“This author hastens to indicate that this is not even Luria’s intention.

who, in what he terms semantic aphasia, sees a disorder of language secondary to a

much more general disturbance of a “complex function of simultaneous spatial

temporal synthesis”.

What Tissot does is to bring his comments to this“base”levelpostulated by Luria.

For him. when Luria talks of a “loss” of the “complex simultaneous synthesis”, he

means. among other things, a d(fficu1t.i. in anal.txzing a complex simrritaneous

datum in a series that de\velops in time and inverse!)?. Tissot approximates this

aphasiological appreciation to the linguistic criterion of Tesniere (1959). who,

according to what the former explained, in constructing his structural synthesis,

states that “to talk is to transform a structural order into a linear order”, while

“understanding is to transform a linear order into a structural order”, as he suggest:,

it, by means of a spatial scheme, through which the function of each word in the


sentence would be indicated. For this linguist, syntax would consist of the study of

such a structure, while morphology would be limited to the study of signs that

would facilitate the transformation of that structural order to a linear order.

Tesniere’s (1959) analysis develops a proposition by Martinet (1960), inasmuch as it

states that the true reason for syntax is to try to explain how one can reduce a fact of

experience, that in itself is not a succession, into a linear succession of discrete

elements,

Tissot continues to explain that in “semantic aphasia” conceived according to

Luria, one of the model difficulties would be the impossibility to grasp, to

und~rsfand. the value of word.? as a~~nctio~z of‘context. For Luria, as for Head,

continues Tissot, the defect of actualization of the contextual sense is connected

with the loss of the possibility, as much to express as to understand, all the

relationships that connect the words in the sentence. “Is it possible to raise the

question,” Tissot asks himself, “if the two phenomena are unconditionally connec-

ted or not?” Be that as it may, these disturbances are the central point of the context

and belong, therefore, to the syntagmatic or contrast function. Thus, for this

author, the “semantic aphasia” of Head and Luria would involve the syntagmatic

central point rather than the semantic level, while the aphasia truly relative to this

other great central point of language would be what Head defines as “nominal”,

erroneously superimposed or approximated to “amnesic aphasia” by many.

Tissot emphasizes that while both Head and Luria give importance to the

parieta( t0pograph.y of lesions that produce a so-called “semantic aphasia”, these

are, instead, ternporal(in accordance with Alajouanine and Lhermitte (I 960)) when

there is a break between significant and signification, this disturbance being

situated in the central point of the lexicon, of the system of paradigm, playing there

the function of opposition. Precisely such a break of the link between signification

is the main fact, for Tissot, of fme semantic aphasia; this is that termed nominal in

the descriptions by Head. In such a case the lack of the correct, appropriate word is

characteristic and is replaced by a periphrasis.

The erroneous form in which, both for Head and Luria, semantic aphasia would

have been delineated, leads Tissot to examine in detail the dissociation that the

aphasic disturbances can create between the two levels: (i) the level of sense, for

one; and (ii) the level that includes at the same time, in Tesniere’s (1959) concept

previously referred to, the structural and linear order of the sentence.

Tissot states that the two levels are not independent, as the second one supports

the first (on the level of sense), but they cannot be confused, he argues. Tissot

explains that subjects with “semantic aphasia”(in the sense of Head and Luria, that

is. in the sense of the lack of the contextual support) could have kept the structural

order as well as the linear order of the sentence, but, for them, such a level would

have lost the value of the support of sense.’ One could perhaps say that the


morphosyntax would become powerless, insufficient, to open access to the level of

sense. this being lost in the contextual “dilution”(converted from support and light

to obstruction and darkness). But this would occur in the specific form at :hr

expense of the loss or erosion of sense( or of significance) of the specified monemes of

a certain type. placed in key positions of linear syntagma. These would be w70~7~~17t~s

with a ke>’ “relational” sense, as are “more than”, “less than” (pairs that we might.

perhaps. define as “syntemes”), “greater”, “ lesser” (or “larger” and “smaller”). “of

(genitive in its attributive function). A branching transformational concept would

permit us to situate the L‘Io~~u.~” of the change producing the loss of semantics ot

what is stated in such cases. We could state that, just as in aphasia c~~u.wt1 !)I’ {I

temporal lesion. a semantic d&w can occur,fi-om the loss qf’the \,alur cif’~hr .sigr~

that a moneme (the minimal sign) has, in Luria’s semantic aphasia, t/w afj&iiu,y t jf’

thr .semantic value ~.ould take plaw at another IeLaeI, that of’the mtrrllal oyuui-

zation of’certain s.l~ntaKmas.

In a comparison of Luria’s classification with others found in the present

literature. it can be stated that those that are closer to a “clinical empiricism’”

emphasize the value of the dichotomy between decreased fluidity and illtact or

exaggerated fluidity (with a tendency towards logorrhea), as well as t.hat u hich

establishes the presence or not of a manifested disturbance of repetition (which, as

Brown (1972) emphasizes, is not, obviously. a linguistic function that can he

individualized).

On the other hand, many anatomo-clinical classifications tend to be supported

by or even exaggerate the separation between aphasias caused by anterior lesions,

whose prototype is Broca’s aphasia, and the aphasias caused by posterior ie\ions.

centered on Wernicke’s aphasia. One is led to the first classification of “motor”

aphasia, and the second, of “sensorial” aphasia, thus reducing the quesuon to an

outline that is both caricatural and incorrect. Geschwind (1984) stated that hc had

repeatedly objected to such a sensori-motor classification as being inaccurate.

Thus, for example. in Broca’s aphasia, there are disorders of comprehension, II!

particular of grammatical comprehension. But, even the terms “motor” and

“sensorial” are not the most appropriate to define the disturbances air language.

especially at specified levels.

In fact, a thorough examination in terms of aphasiology would require. a> has

already been done by others, detailed examination both of the linguistic factors and

those related to neural organization, as well as a balanced approximation between

the two fields. Kean (1984) stated that whereas the structure of language (gram-

mar). the process of language for production and comprehension. and neuro-

anatomy and neurophysiology of language are all conceptually distincl. from each

other, “the study of the aphasias is not itself a conceptual distinct domam

in the sense that there could ever be a characterization of an independent

The Aphasialogy of A.R. Luria 13

level of conceptualization and a representation of human linguistic capacity”.

To speak of cerebral zones in relation to some defined as “articulemes” seems to

us to approach too closely to the old hypotheses of some “centres” (although we

know that Luria thought in terms of “complex functional systems”) in relation to

some “images”.

The neurofinguistic classrjkation tendency is, in fact, a corollary of the classic

aphasiological tradition associated with linguistic knowledge. These classifications

“attempt to integrate the models of contemporary linguistics with the recent

aquisitions in the knowledge of the anatomo-functional organization ofthe brain”.

For Gainotti et af. (1977), the attempts of Hecaen, the directions of Tissot and the

systematization of Luria enter into this sphere. Gainotti and colleagues ascribed to

the neurolinguistic tendency that attempts to differentiate the strictly linguistic

components of aphasic verbal conduct from those other extralinguistic components. We want to point out and retain the following two elements.

(a) Aphasia must be considered as a whole.

(b) The different clinical forms of aphasia are probably due to the super-

imposition of extralinguistic disorders over this central disintegration of language.

The model proposed by Gainotti et al. (1977) is derived from some hypotheses of

generative linguistics and, in particular, the distinction established by Chomsky

between the levels of competence and realization or actuation. The first of these is

considered as a group of rules and interiorized processes, which constitute the

linguistic knowledge of the subject, while the second is considered as the actuali-

zation of such competency in a concrete situation, in which the verbal realization is

defined, not only by the mentioned linguistic competency, but also by non-

linguistic factors (perceptive and motor, praxic, mnesic, etc.). According to

Chomsky, a put~olog~ spec$c to language is oniy caused b_v disorders ofcompe- Ience. Among the disorders placed “befow” the level of competency. we would

mention, as do Gainotti and colleagues, “dynamic” aphasia of Luria, the “syn-

drome of phonetic disintegration” (anarthria) of Alajouanine and colleagues,

“cortical dysart hria” of Bay ( 1964), “speech apraxia” of Darley et al. ( 1975) and

other North American authors. Gainotti and colleagues disagree with Hecaen and

his school insofar as this latter group denies the existence of a break in competency

(only accepting the disintegration of some factors of realization) in any of the forms

of aphasia.

Gainotti and colleagues only want to emphasize “the fact that in many clinical

forms of aphasia there is some involvement of semantic (lexical) structures of

language”. Study of some aspects of comprehension of oral language in aphasias

suggested to Gainotti and colleagues that “ in semantic jargons, the verbal defect is

not due to involvement of one or more components of the system of realization

abilities, but, rather, the break in the true level of integration of language”. For NEL 411-B


them, “the break in the semantic level of integration of language is a basic disorder

in many forms of aphasia”. Patients with amnestic aphasia can present important

errors in semantic discrimination. Moreover, many aphasic patients (Gainotti and

Lemma (1976) and other authors) presented even an impairment of the semantic

sphere that went beyond the verbal field.

We conclude with a brief mention of present-day problems concerning the

written language. Those who maintain the traditional position on the role of

phonemic process in writing, Luria included, maintain that all writing depends on

phonemic mediation. In reality, as argue Shallice and Heilman’s school (Roeltgen

and colleagues), the systems that can intervene in writing are diverse. A phono-

logical system can intervene in the conversion of a phoneme into a grapheme when

one attempts to write unfamiliar words or pronounceable chains of letters that are

not true words. In contrast, there is a lexical system (of evocation of the whole

word) that can be important in writing familiar words, irregular words -~ that

cannot be spelt out by direct conversion of the phoneme to grapheme ~ and

ambiguous words. Roeltgen and Heilman (1984) proposed the existence of two

systems used in the ability to spell: one lexical-semantic and the other phono-

logical. Each one can be affected separately. Lesions also can occur in different

sites. In lexical agraphia, they are localized in the posterior part of the angular

gyrus, while in phonetics, the lesions involve the supramarginal or insular gyrus and

spares the angular gyrus.

Concrete reference to the field of written language includes one of the particular

modifications to be done in the concepts in Luria. Many others can be formulated,

either in a particular field such as this or of a more general nature. But this is beyond

the perspectives of this report.

ACKNOWLEDGEMENTS

The author wishes to thank Drs Jordan Grafman and Irene Litvan for the English

translation of the manuscript.

NOTES

1. Please send all correspondence and reprint requests to: Lluis Barraquer- Bordas, Neurology Department, Sta. Creu i St Pau Hospital, Avgda, St.

Antoni Ma. Claret, 167 HO8025 Barcelona, Cataslonia, Spain,


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the aphasiology of a.r. luria

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