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LANGUAGE AND BRAIN
Rohmani Nur Indah
Objectives: Understanding the role of brain in human communication Exploring the development phases of brain Explaining the relation between brain and language Explaining the nature of aphasia and its types
Instructions: Read the following section on brain and language (Source: Chapter 5, Indah, R. N. & Abdurrahman. 2008. Psikolinguistik: konsep & isu umum. Malang: UIN Press.) What is the relation between brain and language? Elaborate your answer using example(s). Explain the nature of neurolinguistics. What is aphasia? Explain the difference between Broca and Wernicke’s aphasia. Read the class notes on Aphasia. What do you know about the tools or treatment for aphasics? Read text 3 on Anomic and Global Aphasia Do you think that difficulty in memorizing and labeling the names of things suffered since childhood also belongs to anomic aphasia? Why Global aphasia does not affect the intelligence. What does it mean? Can people who experience global aphasia get their ability again? Do you think that bilingual anomic aphasia can affect one’s mother tongue? Write a one page summary on brain and language.
Source: Chapter 5, Indah, R. N. & Abdurrahman. 2008.
Psikolinguistik: konsep & isu umum. Malang: UIN Press.
Manusia dalam proses berbahasa dimulai dari fase enkode semantik, enkode gramatika, enkode fonologi, yang kemudian dilanjutkan dengan decode fonologi, dekode gramatika, serta diakhiri dengan dekode semantik. Proses enkode semantik dan enkode gramatika terjadi dalam otak penutur, sedangkan enkode fonologi dimulai dari otak penutur yang kemudian dilaksanakan oleh alat ucap ( articulator ) di dalam rongga mulut penutur. Berbeda dengan dekode fonologi dimulai dari telinga pendengar dengan lanjutannya berupa dekode gramatika dan berakhir pada dekode semantik. Apabila alat-alat fisiologi penutur dan pendengar berada dalam keadaan sehat-normal, maka pesan semantik yang dikirimkan oleh penutur dapat diterima dengan baik oleh otak pendengar, dan proses berbahasa berjalan dengan baik dan normal. Karena proses berbahasa lebih bersifat dua arah, bersifat bolak balik antar penutur dan pendengar, maka seorang penutur kemudian bisa menjadi pendengar, dan seorang pendengar kemudian bisa menjadi penutur. Begitulah proses tersebut terjadi bergantian, yang secara teoretis berjalan terlalu lama dan panjang, namun sebenarnya dapat berlangsung dalam waktu singkat dan cepat. Semua proses ini dikendalikan oleh otak yang merupakan alat pengatur dan pengendali gerak semua aktivitas manusia.
A. Evolusi Otak Manusia Dalam perkembangannya manusia tumbuh secara gradual dari suatu bentuk ke bentuk yang lain selama berjuta-juta tahun. Salah satu pertumbuhan yang telah diteliti oleh para ahli palaeneurologi telah menujukkan bahwa evolusi otak manusia primata Austrolopithecus sampai dengan manusia saat ini telah berlangsung sekitar 3 juta tahun. Hal ini tampak paling tidak pada ukuran otak yang telah membesar dari 400 miligram menjadi 1400 miligram pada kurun waktu antara 3-4 juta tahun lalu. Dari munculnya Homo Erectus sampai dengan adanya homosapiens pada sekitar 1, juta tahun yang lalu ukuran otak manusia telah mengalami perkembangan hampir
mengartikulasikan ucapan akibat gangguan neuromotor berbicara (Gleason dan Ratner 1998). Perihal bagaimana otak manusia menghasilkan dan memproses bahasa dikaji dalam neurolinguistik sebagai perkembangan dari psikolinguistik. Dalam hal ini yang perlu diangkat bukanlah perbedaan pengaruh otak kanan dan otak kiri pada perilaku manusia, melainkan bagaimana secara anatomis hemisfer kanan dan kiri bekerjasama dalam mengolah informasi kebahasaan. Inilah yang menjadi fungsi utama corpus callosum yang menjadi panel penghubung kedua sisi hemisfer (Schovel, 2004). Untuk komunikasi linguistik pada bagian cortex otak dikenal dua area yang dinamakan area Broca dan Wernicke. Paul Broca, ilmuwan Prancis, yang juga sebagai penemu istilah aphasia, hilangnya kemampuan berbicara atau berbahasa akibat cidera otak, menamai area dasar motor cortex yang mempengaruhi kefasihan berbicara. Kerusakan pada area Broca berakibat pada kemunduran kemampuan baca tulis, keraguan berbicara dan bahkan pada beberapa kasus muncul gagap. Namun demikian kemampuan memahami bahasa tidak bermasalah. Apabila cidera otak terjadi pada bagian belakang telinga, yaitu pada area Wernicke, akibatnya akan berbeda. Karl Wernicke, penerus Broca yang berasal dari Austria, meneliti dampak cidera pada sensory cortex. Penderitanya akan mengalami kesulitan dalam mengolah masukan linguistik meskipun secara umum kemampuan baca tulis tidak terlalu terpengaruh. Penderita Wernicke’s aphasia lebih fasih daripada penderita Broca’s aphasia, namun demikian cara bicaranya cenderung bergumam dan tidak jelas ke mana arah pembicaraan yang dimaksudnya. Cidera pada otak berakibat fatal terhadap perkembangan dan kemampuan berbahasa. Adanya kelainan dalam sistem otak yang kompleks dipelajari dalam relasi neuropatologi dan gangguan komunikasi. Gleason dan Ratner (1998) menjelaskan bahwa terdapat penyebab cidera otak selain kecelakaan yaitu karena adanya penyakit cerebrovascular yang membunuh jaringan saraf dan memotong aliran darah ke otak yang membutuhkan suplai glukosa dan oksigen. Penyakit lainnya yaitu trauma, tumor dan hydrosephalus yang menggerogoti jaringan saraf sehingga fungsinya terganggu. Penyakit lain seperti multiple sclerosis mengikis lapisan myelin pada otak sehingga
hubungan antar saraf terganggu. Penyakit Hutington dan Parkinson juga muncul akibat ketidaksingkronan hubungan antar saraf. Relasi antara cidera otak dan gangguan berkomunikasi ditunjukkan pada tabel berikut.
Tabel Jenis Neuropatologi dan Jenis Gangguan Berkomunikasi Jenis Neuropatologi Jenis Gangguan Berkomunikasi Penyakit Cerebrovascular (hemorrhage, aneurysm, arteriovenous malformation)
Aphasia, dysathria, dementia
Penyakit degeneratif ( Alzheimer, Pick) Dementia Trauma di kepala Aphasia, dysathria, kebingungan berbahasa Parkinson Dementia, dysathria Multiple Sclerosis Dysathria Hidrosefalus Aphasia Tumor Aphasia dan/atau dysathria Huntington’s chorea Dementia dan/atau dysathria Ataxias hereditas Dysathria Amyotrophic lateral sclerosis Dysathria Myasthenia gravis Dysathria
Cidera pada otak sebagaimana yang dijelaskan di atas mengarah pada hilangnya kemampuan berbahasa. Kompleksitas bahasa manusia tercermin dari munculnya beberapa anomali komunikasi seperti yang dicontohkan pada tabel di atas. Selain itu, dalam neurolinguistik telah dikaji bahwa kemampuan berbahasa sangat dipengaruhi oleh kemampuan otak memproses informasi. Sebagaimana yang dibuktikan dalam beragam aphasia, kemampuan berbahasa lebih banyak dipengaruhi hemisfer kiri. Namun dari beberapa bukti keberhasilan operasi otak ternyata dapat disimpulkan bahwa kemampuan berbahasa dan berbicara tidak mutlak terpusat pada satu area sisi otak. Pada anak kecil, awalnya fungsi kebahasaan dikendalikan oleh
Hubungan antara otak dan bahasa awalnya ditengarai dari adanya kerusakan pada otak yang mempengaruhi kemampuan berbahasa. Hal ini dikemukakan oleh Edwin Smith, ilmuwan Amerika, yang menemukan lembar papirus pada tahun 1862 yang menyebutkan adanya 48 kasus yang terjadi pada tahun 3000 SM. Kasus ke-22 menjelaskan tentang kerusakan otak akibat cidera kepala yang mengakibatkan hilangnya kemampuan berbicara. Aphasia adalah hilangnya kemampuan berbicara dan berbahasa akibat cedera otak. Contohnya Broca’s aphasia yang berakibat pada kemunduran kemampuan baca tulis, keraguan berbicara dan bahkan pada beberapa kasus muncul gagap. Namun demikian kemampuan memahami bahasa tidak bermasalah. Adapun pada Wernicke’s aphasia penderitanya akan mengalami kesulitan dalam mengolah masukan linguistik meskipun secara umum kemampuan baca tulis tidak terlalu terpengaruh. Penderita Wernicke’s aphasia lebih fasih daripada penderita Broca’s aphasia, namun demikian cara bicaranya cenderung bergumam dan tidak jelas ke mana arah pembicaraan yang dimaksudnya. Hubungan antara bahasa dan pikiran tampak dari adanya kemampuan dan ketidakmampuan berbahasa yang terkait dengan peranan otak baik hemisfer kiri maupun kanan yang mengelola masukan linguistik.[]
Text 2: CLASS NOTES
APHASIA
Aphasia is a condition characterized by either partial or total loss of the ability to communicate verbally or using written words. A person with aphasia may have trouble speaking, reading, writing, recognizing the names of things, or understanding what others say. Aphasia is caused by brain injury, as may occur during a traumatic accident or when the brain is deprived of oxygen during a stroke. It can also be caused by brain tumors, such as Alzheimer's disease, or infections, such as encephalitis. Aphasia may be temporary or permanent. Aphasia does not include speech difficulties caused by loss of muscle control (Llussa`, 2010).
A. Broca's Aphasia
Broca's aphasia, or called motor aphasia, results from damage to the front or frontal lobe area of the brain dominant language. Individuals with Broca's aphasia may actually not be able to use speech (mute) or may be able to use a single statement said or even full sentences, although these sentences may require a lot of effort to build. Small words, like conjunctions (and, or, but) and articles (the, a, a), can be eliminated, leading to "telegraph" quality in their speeches. Hearing comprehension is usually not affected, so that they are able to understand speech and conversation of others and can follow orders. Often, they may be experiencing weakness on the right side of their body, which can make it difficult to write. The ability to read is interrupted, and they may have trouble finding the right words when speaking. Individuals with Broca's aphasia may become frustrated and depressed because they realize their language difficulties. Several studies also show that in Broca’sApahasia the production of verbs is more impaired than the production of nouns (Bastiaanse & Zonneveld, 2003). Initially, the cause of aphasia must be treated or stabilized. To regain language function, therapy should be initiated as soon as possible after the injury. Although there is no medical or surgical procedures currently available to treat this
to reflect impaired access to stored lexical information. However, Broca’s aphasics show signs not just of being unable to use functors appropriately but also of being unable to understand them. The fact that the symptoms of aphasia vary considerably from patient to patient suggests that the language-sensitive areas of the brain may be differently located in different individuals. Alternatively, particular language functions may be so localised that a great deal depends upon the exact position of the lesion which inflicts the damage. Recent brain imaging data suggests a third possibility: the reason for the vulnerability of the Broca and Wernicke areas is that they constitute a major crossroads for the neural connections which transmit widely distributed linguistic information across the brain (Field, 2004). Instead of relating type of aphasia to the area of the brain in which damage has occurred, clinicians prefer to analyse symptoms. A first observation might consider the extent to which lexical-semantic processing is impaired, as against grammatical or sentence processing. However, a distinction is still often made between non-fluent aphasia of the Broca type and fluent or expressive aphasia of the Wernicke type.
B. Writing Treatment for Aphasia: A Texting Approach A study on the treatment for aphasic is published in journal of speech, language, hearing research of American Speech-Language-Hearing Association. It was done by Beeson et al in 2013. It is the latest research working on the treatment for people with Aphasia. It focuses on writing treatment for aphasia using texting approach from cell phone, because their consideration about the increasing role of electronic communication reliance. In which, individual with aphasia may have the need, or desire to communicate electronically. Further, people with limitation in spoken language may be assisted by the function of written communication that proves to be the primary modality for the successful exchange of information (Beeson, 1999; Clausen & Beeson, 2003; Robson, Marshall, Chiat, &Pring, 2001). The study aims to understand whether the treatment using typing feature of cell phone can help people with aphasia to communicate or not. Applying the text
message for communicating is the clear goal of this research. Additionally, the study includes Mr. J, a person with aphasia, whose age is 31st, previous study’s method that was CART (Copy and Recall Treatment), an Alltel LG cell phone with a slide out QWERTY keyboard as the particular element for the research. The findings in that study shows that texting method is related to handwriting treatment that is known as CART. Typing, like handwriting, involvessemantically guided retrieval of appropriate words and theircorrect orthography. Spellings can be retrieved as lexical–orthographic representations or assembled with reliance onphonology (Hillis & Rapp, 2005; Rapcsak & Beeson, 2004;Rapp, 2002). However, the peripheral demands for keyboardand cell phone typing differ from those for handwriting,which requires specific letter shape (allographic) knowledgeand graphomotor movements to construct individual letters (Beeson et al, 2013). Next, the treatment was conducted in 1 hour session weekly for 13 weeks. Mr.J learned how to memorize word using both handwriting and texting using cell phone. As the result, he could memorize 3 of 30 words by handwriting, while 0 of 30 words by typing. However, he continuously got the treatment using cell phone. The last result showed that spelling and spoken naming conducted for Mr. J gave a good result. The training resulted in functional use of texting that continued for two years after treatment. However, the study suggests a copy and recall methodology can be effective for trainingsingle-word spelling using the texting function on a cellphone in a similar manner that with pen and paper (Beeson et al, 2013).
C. Picture Naming pre and post rTMS to treat Aphasics
Based on the research by Naesar et al (2004), picture naming in pre and post repetitive Transcranial Magnetic Stimulation (rTMS) belongs to a treatment for aphasics.. rTMS can affect in language improvement, ranging from facilitating of naming to speech arrest.
Text 3: ANOMIC AND GLOBAL APHASIA
1. ANOMIC APHASIA
Anomic aphasia, commonly known as nominal aphasia, is a disorder which causes problems with recognizing words or naming objects which the subject should know well (Cafuz, et al., 2013). Anomic Aphasia Characteristics The characteristic of Anomic aphasia is categorized by difficulties in recalling words or names of people, places, things and others. Patients suffering from aphasia usually speak indirectly to express certain words that they do not remember the name. In cases speech production is fluent but contains semantic paraphasias (usually with obvious similarity to the target word), sometimes they need some instructions to help them remember the names or words. They actually can speak with correct grammar; however, they have problems in finding the right words of people names or objects. In certain cases, they basically know the function and the way to use the object, but they still cannot give the name and label for the object. For example, if a patient is shown an object like orange and asked what was called, they may be aware that the object edible. However, they do not remember that the object is called orange. They just remember that they have ever eaten it. Because of those difficulties, he or she struggles to find the appropriate words for speaking, understanding, reading, and writing. In acute cases there can be long pauses during which patients search for words with great effort, these pauses are often filled with set phrases. Patients are often frustrated when they know they know the name, but cannot produce it. Difficulties in word retrieval may manifest themselves by hesitations or a lack of response, or by one of the following errors:
- semantic paraphasias: errors in word-meaning; often words are selected that have semantic features in common with the target (e.g. apple instead of pear)
- phonological paraphasias: errors in word-form, i.e. in the selection and sequencing of word sounds (tear, or a non-existent word like kear, instead of pear)
- neologisms: unintelligible words (saggel)
- superordinates and generalisations: e.g. fruit or thing instead of pear
- circumlocutions, e.g. something you can eat, it grows on a tree
- recurring utterances: repetitive sounds words or phrases, e.g. du.du.du.; I’m a stone, I’m a stone. (Code in Doesborgh, S.J.C. ,2004).
There are three main types of anomic aphasia:
- Word selection Anomia
It occurs when the patient knows how to use the object and selects the target objects correctly from several groups of objects yet cannot name the object. The patients can separate colors into categories, but they cannot name them.
- Semantic Anomia
It is a disorder in which the meaning of words becomes lost. Unlike patients with word selection, patient with semantic anomia cannot select the object correctly from a group objects even provided with the name of target objects.
- Disconnection Anomia
It is caused by the severing of connections between sensory and language cortices. Patient with disconnection anomia is limited to a specific modality. For example, when the patient is limited to a specific sensory modality, such as hearing, they may able for naming the object when it present through audition and may not be able to mention the same object when it presented visually. This case is the consequence of disconnecting between the visual cortex and language cortices. Patients with disconnection anomia may also exhibit callosal onomia, in which damage to the corpus callosum, prevents sensory information from being transmitted between the two hemispheres of the brain. For instance, if a patient with this type of disconnection anomia holds an object in their left hand, the sensory information about the object
comprehension. The syndrome is usually due to a large lesion of the left perisylvian cortex.” Indah (2011) states that people who suffer global aphasia experiences complex difficulties due to damage to the entire left hemisphere. They are usually poor in speaking spontaneously and cannot listen and repeat the sentences. Another source also states that global aphasia is an extreme impairment or loss of language ability in all input and output modalities. It means that the individual who suffer of global aphasia has poor language comprehension as well as the inability to speak or write. Characteristic Ozeren et. al. (2006) states that a characteristic of this communicative disorder involves serious impairments in all aspects of speech and language. Such effects can result from lesions in the 'anterior-posterior' areas of the brain. People who suffer global aphasia have many characteristic that we can know from their language. There are several characteristics which are possessed by them, such as: People with global aphasia have a lot of trouble with speaking, writing, understanding and reading. Speech: either mute or effortful with repetitive vocalizations of single words/syllables. Reading and writing: writing is not possible, reading comprehension worse than listening comprehension. People with global aphasia have severe communication difficulties and may be extremely limited in their ability to speak or comprehend language. When trying to communicate something else, naming, repeating, and auditory comprehension are extremely impaired.
Obler & Gjlerlow (2000:40) have made a summary about aphasia in this table:
Aphasia
Language production Understanding^
Repeating word Labeling
Brain injury
Broca Not fluent^ Good^ Bad^ Bad^ Anterior
Wernicle Fluent Bad Bad Bad Posterior
Global Unable Bad Bad Bad Wide
Causes Global aphasia is usually caused by injuries to language-processing areas of the brain, notably Wernicke's and Broca's areas. Many times, the cause of the brain injury is a stroke. It occurs when blood is unable to reach a part of the brain. Brain cells die when they do not receive their normal supply of blood, which carries oxygen and important nutrients. Other causes of brain injury are severe blows to the head, brain tumors, brain infections, and other conditions that affect the brain. Symptoms of global aphasia The symptoms of global aphasia effect processing difficulties in wernick’s and broca’s area (NHS, 2012). These are ordinarily assign word and meaning, string word together, and complete other word based task. Because of that reason, the symptoms of global aphasia are impairment in all aspect of word such as communication, reading, writing, speaking, and understanding aspect. Moreover, the exact symptom is different from individual to individual. For instance, some global aphasic person do not understand speech at all, while other recognize familiar personal names and are able to follow whole body commands. In addition, some individuals are mute while other can produce a few sounds (e.g. ta..ta..) or stereotypic phrase (e.g. we said). According to NHS (2012), other symptoms of global aphasia can include paralysis of the right side of the body, some loss of vision, loss of voluntary control of their limbs, problems pronouncing certain sounds and words due to difficulties controlling the mouth, tongue and voice box.
According to Towey and Pettit (n.d.), there are nine areas which involved in the treatment of global aphasia through a communication competence approach. Those are a. Verbal behavior Names: by using patient’s name we can build a good relation with the patients which is very important in the treatment process. For knowing this, we should interview family and friends of the patient what are the preferred manner of addressing the person. Verbal response: verbal responses are used to indicate understanding of, and feeling for, other person’s situation, in attempting to respond to the effective needs of a patient. Avoiding interruption: rhythm, intonation, and speaker behavior are all used to determine when a message is complete, to avoid the rejection and frustration associated with the interruption of a message that may be unintelligible. In addition, increased understanding on the part of the listener facilitates improved communication and interaction. b. Non-verbal behaviors Eye contact: waiting for and maintaining eye contact is seen as important in keeping the channels of communication. Lack of aye contact may signify excessive anxiety, poor self-image or rejection by the patient. A blank look may indicate depression or lack of understanding. Moreover, good eye contact is generally felt when the listener utilizes glances of three to ten seconds in length. Head nods: observation of the presence or absence and rate of head nods can indicate participation, understanding, and desire to response within an interaction. Head nodding that is done slowly may indicate that the listener is relaxed and attending to the speaker, while increased speed of head nod may indicate that the listener is prepared to take a turn in the interaction or is becoming anxious or impatient.
Facial expressions: facial expression is used to indicate support, empathy, and pleasantness. Facial expression may also convey concern, anxiety, fear, depression and support. In addition, facial expression can be used not only convey those feeling to patient but also to assist in understanding the patient’s intent. Reciprocity of affect: smiling, laughing, frowning, scowling, and other cues are response to in reflection of the effect that is displayed by the patient. c. Proximic Consideration Physical proximity: positioning can be used to indicate support, comfort, and contact with the patient. A patient’s need for space must be respected based upon observation with different kinds of physical contact in space. By making and giving the best space with the patient, it can make help the patient. Postural cues: postural cues include rocking movements and leg and foot movement to indicate anxiety, comfort, participation, and attention. Observation of postural clues provides information about the quality of the interaction and opportunity to more appropriately respond to the needs of the individual.
References
Alexander M. P. & Loverso F. 1992. Clinical Aphasiology. A Special Treatment for Global Aphasia. pp. 277- 279. Vol 21. http://aphasiology.pitt.edu/archive/00001458/01/21-27.pdf
Anomic Aphasia. n.d. In Wikipedia. Retrieved April 27, 2014, from http://en.wikipedia.org/wiki/Anomic_aphasia
Boyle, M. and Coelho, C.A. (1995). Application of Semantic Feature Analysis as a Treatment for Aphasic Dysnomia. American Journal of Speech-Language Pathology, 4 (4), 94-98. doi:1058-0360/95/0404-
