Aphasia: Historical Development, Legal Implications, and New Developments | Study notes Communication

Aphasia and the Expert Medical Witness

RICHARD

T.

AND

ROBERT

RADA,

M.D.,

BRUCE

E.

KELLNER,

M.D.,

PH.D.-

Introduction

PORCH,

PH.D.,

The

incidence

of

cerebral vascular accident

in

the

U.S.

is

200

per

100,000

population

of

all ages,l

or

approximately

400,()()0

new strokes

per

year. Many

of

these patients develop

acute

or

chronic aphasia.

When

the

mental

capacity

or

legal competence

of

the

aphasic

patient

is

ljuestioned, it

is

frequently the psychiatrist whose

expert

testimony

is

requested.

In

1900,

Dr. Charles MiIIs,

writing

in the textbook

entitled

A System

of

Legal

Medicine,2

noted that the medical-legal aspects

of

aphasia had received little

attention

by compari-

son with

the

immense

literature

on

the general topic. A review

of

the recent medical

and

legal

literature

indicates that the situation remains unchanged today.

The

purpose

of

this

paper

is

to present a brief review

of

the historical development of aphasia,

of

aphasia as a legal matter,

and

of new developments in the field

of

aphasiology,

and

a

case illustration

of

combined

expert

testimony between a speech pathologist

and

a

psy-

chiatrist

in

a case involving child custody.

Definition of

Aphasia

Dorland's medical dictionary defines aphasia as

"a

defect

or

loss

of

power

of

expression

by speech, writing,

or

signs,

or

of

comprehending

spoken

or

written

language,

due

to

injury

or

disease

of

the

brain

centers."3

Injuries

to the

brain

frequently produce deficits

which

in

some way affect the

mental

capabilities

of

the

patient.

Damage to the left

hemisphere

is

frequently associated with the reduction

or

loss

of

communicative ability,

and

the

patient

is

described

as

having aphasia.

His

reduced capacity for carrying

out

all

encoding

and

decoding processes can be documented

and

various degrees

of

deficit can

be demonstrated in

the

broad areas

of

reading. writing. speaking

and

understanding.

Operationally.

the

brain

loses some

of

its ability

to

receive

and

send information, al-

though its

other

processes may remain intact.

Depending

upon

the

extent

of

breakdown

in communication, the

patient's

capacity to

handle

personal

and

social interaction may

be questioned.

The

Historical Development of

Aphaslology

The

modern

history

of

aphasia begins

in

the early

nineteenth

century with Franz

Joseph Gall,

better

known (or his theories

of

phrenology .• Gall was

the

first to suggest

that

linguistic capacities are functions of circumscribed

brain

areas.

In

1861, Broca

li

described

patients

who lost speech following damage to

the

third

frontal convolution.

He

presumed this area to be a

"center"

for

the

motor

images

of

speech. Shortly there-

after, Wernicke6 presented his first

paper

on aphasia associated with lesions

of

the

left

temporal lobe

and

suggested

that

in

addition

to the

motor

aphasia noted by Broca there

-

The

authors

are

all associated with the University

of

New Mexico School

of

Medicine. Dr.

Rada

is

Associate Professor

of

Ps~chiatrY;

Dr. Porch

is

Associate Professor,

Department

of

Communicative Disorders; Dr.

Kelln~r

is

Pr~fessor

of Psychiatry.

The

authors

wish to thank JanJues

M.

Quen, M.D

..

for suggesting the Benjamin Rush quotation.

231

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Aphasia and the Expert Medical Witness

RICHARD T.

AND ROBERT

RADA, M.D., BRUCE E.

KELLNER, M.D., PH.D.-

Introduction

PORCH, PH.D.,

Definition of Aphasia

The Historical Development of Aphaslology

The Bu'Ie'" r

TABLE I

j

26. Usdin GL: The physician and testamentary capacity. Amer J Psych 114:249. 1958

28. Morse HN: The aberrational man-a tour de force of legal psychiatry. J Forensic Sci U:I-32.

36. In Re Comfort. 63 N J. Eq. 377.55 At. U5. 155 (1902)

40. Porch BE: Multidimensional scoring in aphasia testing. J Speech Hearing Res 14:776-792.