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Aprosodias

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Aprosodias are defined as acquired or developmental conditions marked by an imparied ability to comprehend or generate the emotion conveyed in spoken language. Aprosodia is a neurological condition characterized by the inability of a person to properly convey or interpret emotional prosody. Prosody in language refers to the ranges of rhythm, pitch, stress, intonation, etc. These neurological deficits can be the result of damage of some form to the non-dominant hemisphere areas of language production. The prevalence of aprosodias in individuals is currently unknown, as testing for aprosodia secondary to other brain injury is only a recent occurrence.

Causes

Localized Brain Damage

One cause of aprosodia is suffering brain trauma to one of several specific areas of the brain, resulting in the inability to properly process or convey emotional cues. This brain damage can occur in the form of ischemic damage from stroke,[1] removal during surgery, brain lesions, or trauma such as a localized bullet wound. It is worth noting however, that this localization occurs over a range of areas that can vary from person to person and more research is required to further define these areas. Diagnostic confirmation of aprosodia using brain scanning techniques is a relatively recent occurrence, at least with respect to quantitative specificity.[2] As brain imaging techniques are refined to allow for greater temporal and spatial resolution, it is hoped that more will be able to be learned about aprosodias at a functional anatomical level.

Alcohol Abuse

An inability to process or exhibit emotions in a proper manner has been shown to exist in alcoholics and those who were exposed to alcohol while fetuses (FAexp). Initially, when detoxified alcoholics and FAexp individuals were tested for impairment in cognitive function, it was limited to testing the non-affective aspects of language, as those were the more easily recognized by a physician not trained in analyzing affective prosody. When tested using the aprosodia battery, it was found that detoxified alcoholics and FAexp individuals demonstrated significant impairment in their ability to detect affective prosody when used by others. The major factors which influence affective prosody in those impacted by alcohol use, from greatest to least impact, are: alcohol use by mother, age at onset of chronic abuse of alcohol, age at initial abuse, how chronic the abuse is, and the age when a person first becomes drunk.[3]

Aprosodia as a Symptom

Aprosodia has also been shown to appear secondary to several diseases such as multiple sclerosis or post traumatic stress disorder.[4]It is likely that as time passes more diseases will be shown to exhibit aprosodia as a symptom. Aprosodia is a condition that was not often tested for in the presence of neurological deficits; however, as more becomes known about it, the aprosodia battery will likely be administered more frequently. For example, the first study testing for aprosodia in MS did not occur until 2009.[5] This is surprising given that changes in emotional affect would be expected to be noticed in patients exhibiting other changes in speech patterns. This is especially so given that the patients tested in these studies scored poorer than the controls by a statistically significant amount.

Brain Regions

Research into the perisylvan region of the right hemisphere has shown that there are similarly mapped analogues to the speech center in the left hemisphere. This is especially evident in those areas resembling Broca's area and Wernicke's area.[6] The similarity of these regions has led scientists to view aprosodias in a similar manner to how some aphasias are viewed. Because the presence of an aphasia is often more pronounced in an individual than an aprosodia might be, apahsias have traditionally been more heavily studied. Because aphasias are rooted in deficiencies in language modalities rather than affective aspects of language, it has been easier to characterize the underlying impairment caused by brain damage (e.g. inability to choose the right word or inability to speak due to motor control). Combining aphasic research with right-left analogue mapping has allowed for researchers to produce hypotheses on the underlying process behind various aprosodias.
Additionally, in studying the brain regions associated with aprosodia, brain imaging tests were performed to determine if aprosodia is both a lateralized and dominant function of the right hemisphere areas of language production. Aprosodia can be considered a dominant function of the right hemisphere because strong correlation was found between deficits in affective prosody and distribution of lesions in the cortices of those with right brain damage. No correlation was found between the distribution of cortical lesions in patients with left brain damage and the types of aphasic deficits pronounced in those patients. Aprosodia can be considered a lateralized function of the right hemisphere because of the differences in the ability of a patient to respond to affective prosodic information in those with left brain damage when compared to those with right brain damage. Patients with affective-prosodic deficits in the left hemisphere (dysprosodic patients) showed improvement in understanding and repeating prosodic information when other conveyed linguistic information was simplified, i.e. requiring the patient to mainly determine prosodic information contained in an interaction. This improvement in processing affective prosodic information under reduced linguistic processing demands did not occur for patients with right brain damage.[7]

Types

Aprosodias have several subtypes:

  • Motor aprosodia
  • Sensory aprosodia
  • Global aprosodia
  • Transcortical motor aprosodia
  • Transcortical sensory aprosodia
  • Mixed transcortical aprosodia
  • Expressive aprosodia – Disruption in pitch, loudness, rate, or rhythm that convey a speaker’s emotional intent. It can have devastating effects on communication and personal relationship. It is less awareness than for aphasia. Partner or family may think they have become “uncaring”

Motor

A motor aprosodia is characterised by the inability of a patient to produce or imitate emotional indicators, mainly through prosody or facial gestures. Those exhibiting only a motor aprosodia are still able to understand affective prosody when spoken by another, but are unable to respond in the same manner. This is believed to occur due to problems at the execution level of affective prosody. A patient may have an understanding of what emotion they wish to produce, but damage to the motor areas of the brain causes an impairment in the uttering of affective prosody.[7]

Sensory

Sensory aprosodia, also referred to as receptive aprosodia, is characterized by the inability of a patient to comprehend or repeat emotional gestures. A patient with receptive aprosodia also has difficulty identifying emotions presented. In extreme cases of sensory aprosodia, a patient may have difficulty discerning the changes in stress and intonation.[8]

Mixed

Mixed aprosodia is characterized by combinations of the other forms of aprosodia. It is often likely that an aprosodic individual will exhibit mixed aprosodia with varying degrees of intensity among the different aprosodias.

Expressive

Expressive aprosodia occurs when a patient is unable to properly produce the intended emotional cues to those around them, owing more from an inability to produce them at the cognitive than motor level.[2] It is believed that expressive aprosodia results from a lack of an emotional dictionary, much in the same way that patients with dominant hemisphere damage in the same area have a diminished ability to choose the right word.

Diagnosis

Emotional Batteries

Emotional Batteries consist of asking patients to read various sentences with specific emotional indicators. Their performance is subjectively analyzed by an expert to determine if they are aprosodic. The analysis is often performed by two experts independently, with one of the judges not being present during the interview in case the patient was still able to use facial cues.[9]

Assessment Questionnaire

Another method implemented to test for aprosodia involves having questionnaires filled out by those close to the patient. The doctors and nurses taking care of a patient are also requested to fill out a questionnaire if aprosodia is suspected. This diagnosis method occurs more as an indicator that the aprosodia battery should be administered rather than being used as a singular diagnosis tool. Implementation of the questionnaire is expected to become more widespread as aprosodia is revealed to be a side-effect of more diseases.[9]

Aprosodia vs. Dysprosody

Brain imaging studies related to speech functions have yielded insights into the subtle difference between aprosodia and dysprosody. The major differences in these result from functions which are characterized as belonging mainly to the left or right hemisphere. Several of the functions have been described as dominant and lateralized functions of the corresponding hemispheres, while some have been found to arise from communication between the two hemispheres.[7] While the ability to express or be receptive to affective prosody is similar in dysprosody and aprosodia, a significant difference in the characterization of them is dominant vs. non-dominant hemispherical damage.

Impact

The loss of ability to express and understand emotions is debilitating to those experiencing aprosodia. It has a large impact on their lives and affects their day-to-day interactions with others. While it is often overlooked, affective prosody is as integral to communication as the ability to form and understand correct words. Patients exhibiting extreme cases of aprosodia speak in a monotone fashion and are barely able or unable to distinguish changes in stress or intonation.

Treatment

Due to the rarity of reported aprosodia cases, only a few labs are currently researching treatment methods of aprosodia. The largest study of treatments for aprosodia consisted of only fourteen individuals, resulting in sample sizes too small to report statistical significance when comparing one treatment to another. However, the data gained from this study still yielded some results and is being used in the next iteration of aprosodia research.

Methods

The two main forms of treatment are cognition based and imitation based. Cognitive treatments attempt to rebuild the "emotional toolbox" of those with aprosodia. The basis for this treatment is the belief that there exists a defined set of emotional responses that can be chosen for a given scenario. Choosing the proper emotional response can very much be likened to choosing the proper word when describing an object, and this deficiency can be likened to Broca's Aphasia but for emotions. Imitative treatments attempt to help "kickstart" the motor systems involved in the production of both vocal and facial emotive gestures. The basis for this treatment is the belief that the pathways responsible for the motor elements of expressive prosody were damaged. It is hypothesized that the motor damage occurs at the level of planning as well as the level of execution.[10]

Progress

The methods of treatment are being evaluated and changed through several iterations to reach the most beneficial treatment for those with aprosodia. Although the biggest limitation on progress of aprosodia treatment is sample size, some significant data has been found to influence each subsequent phase of study. The Rosenbek lab at the University of Florida is currently in a new phase of treatment study based on combinations of the cognitive-linguistic and imitative therapies delivered in a randomized fashion in an effort to gain more insight into what most prominently affects aprosodia treatment.[9]

See also

References

  1. Heilman, K. M., Leon, S. A., & Rosenbek, J. C. (2004). Affective aprosodia from a medial frontal stroke.[Article]. Brain and Language, 89(3), 411-416
  2. 2.0 2.1 Williamson, J. B., Harrison, D. W., Shenal, B. V., Rhodes, R., & Demaree, H. A. (2003). Quantitative EEG diagnostic confirmation of expressive aprosodia. [Article]. Applied Neuropsychology, 10(3), 176-181.
  3. Monnot, M., Nixon, S., Lovallo, W., & Ross, E. (2001). Altered emotional perception in alcoholics: Deficits in affective prosody comprehension. [Article]. Alcoholism-Clinical and Experimental Research, 25(3), 362-369.
  4. Freeman, T. W., Hart, J., Kimbrell, T., & Ross, E. D. (2009). Comprehension of Affective Prosody in Veterans With Chronic Posttraumatic Stress Disorder. [Article]. Journal of Neuropsychiatry and Clinical Neurosciences, 21(1), 52-58.
  5. Beatty, W. W., Orbelo, D. M., Sorocco, K. H., & Ross, E. D. (2003). Comprehension of affective prosody in multiple sclerosis. [Article]. Multiple Sclerosis, 9(2), 148-153.
  6. Bookheimer, S. (2002). Functional MRI of language: New approaches to understanding the cortical organization of semantic processing. [Review]. Annual Review of Neuroscience, 25, 151-188.
  7. 7.0 7.1 7.2 Ross, E. D., & Monnot, M. (2008). Neurology of affective prosody and its functional-anatomic organization in right hemisphere. [Review]. Brain and Language, 104(1), 51-74.
  8. Raithel, V. (2005). Perception of Intonation Contours and Focus by Aphasic and Healthy Individuals [Book]. pp. 28-29.
  9. 9.0 9.1 9.2 Rosenbek, J. C. (2009, October 6). Chair - Department of Communicative Disorders, University of Florida. [Telephone interview]
  10. Rosenbek, J. C., Rodriguez, A. D., Hieber, B., Leon, S. A., Crucian, G. P., Ketterson, T. U., et al. (2006). Effects of two treatments for aprosodia secondary to acquired brain injury. [Article]. Journal of Rehabilitation Research and Development 43(3), 379-390.
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