Protocols and their use in

aphasia therapy
Rka Kutasi
University of Medicine and Pharmacy
Tirgu Mures, Romania
 Throughout the years scientists have been intensively preoccupied
with the study of the origins and evolution of a language.
In order to obtain a clear and concise evidence disciplines like
linguistics, psychology, neuroanatomy etc. have been included in
this study thus emphasizing the interdisciplinary nature of the
evolution of languages.
According to Ardila,(A Proposed Neurological Interpretation of
Language Evolution, 2015) there are three different stages in
human language evolution:
Primitive communication systems;
Initial language systems;
Advanced communication systems.
 There are two main areas/systems of the brain that are involved in
language processing:

Lexical/Semantic system (temporal lobe)

Grammatical system

Due to certain neurological disorders, stroke, head injury or brain

tumour, these two systems of the brain may be injured, causing serious
language disorders aphasia.
 Definitions of aphasia:

the loss or impairment of language function caused by brain damage (D. Frank
Benson and Alfredo Ardila, Aphasia: A Clinical Perspective,1996)

a language disorder that occurs in adults following focal brain damage, typically
involving the language dominant cerebral hemisphere (A.L. Holland, D.S. Fromm, F.
DeRuyter, M. Stein, Treatment efficacy: aphasia, 1996)

a disturbance of form, expression and symbolic comprehension (Alexandra

Ciocrlan, Radu Drgulescu, Distorsionri ale comunicrii. Cercetri de
psiholingvistic,2013)
 There are two basic aphasia syndromes:
o Brocas aphasia (non-fluent or expressive aphasia)

o poor vocabulary including only a few words or syllables, the patient thus
adopting a telegraphic style;
o phonematic paraphasias or phonetic disintegration (production of
linguistic structures, especially words with incorrect phonemes);
o syntax disorder (agrammatism);
o word finding problems;
o poor pronunciation;
o poor melodic prosody;
o poor right-hand writing;
o depressiveness;
o limited communication.
o Wernickes aphasia (fluent aphasia)

o inability to understand written and spoken language;

o verbal diarrhea;
o semantic paraphasias (word salad);
o the use of neologisms;
o paragrammatism the substitution (or omission) of grammatical morphemes
in spontaneous speech;
o alexia - loss of the capacity to read;
o inability to communicate.
 The mentioned errors have an essential role in the classification
assessment and remediation of language disorders, but they do not
offer enough information for the language pathologist or clinician to plan
treatment as it is a great demand to assess the deficits underlying these
symptoms from a linguistic point of view. This analysis can be performed
with the help of several tools by analysing patients discourse.
In order to obtain a clear and concise analysis of discourse scholars use
standardised protocols encompassing four different discourse genres:
personal narratives, picture descriptions, storytelling, and procedural
discourse.(M.M. Forbes, D. Fromm, B. MacWhinney, AphasiaBank: a
resource for clinicians, 2012)
 Sessions are organised, where aphasic patients are asked to produce
discourse with the help of these protocols. Each session is either audio
or video recorded. Hence the researcher is able to convert the
transcriptions to the CHAT (Codes for the Human Analysis of Transcripts)
standard that contains specific extensions for aphasic language and
analyse them with the help of a special program such as CLAN
(Computerized Language Analysis ) designed by Brian MacWhinney in
2000.
o The first session:
o personal narrative
o Stroke Story and Coping
o Important Event

o The second session:

o picture description
o four- panelled image in which a child breaks a window while
kicking a soccer ball, named as Broken Window;
o a six-panelled picture representing a child who refuses an
umbrella and is caught in the rain referred to as Umbrella;
o a drawing made by Nicholas and Brookshire representing the
rescue of a cat who got stuck in a tree Cat rescue.
o The third session:
o Storytelling - patients are asked to narrate the Cinderella story.

o The fourth session:

o Procedural discourse - participants are asked to recount the
making of peanut butter and jelly sandwich with the help of
additional photographs.
o An independent protocol -The Famous People Protocol - useful for
evaluating spoken language abilities
o aphasics need to recognise certain famous people (singers, actors,
presidents, etc.) and give some details about them.
 Aphasiabank - no Romanian protocols
The need to create a Romanian database of samples recorded with
Romanian aphasic patients by using the translated and adapted
protocols to the Romanian standards.
The descriptions, details, advice, datasheets are going to be translated
into Romanian and three out of the six protocols are going to be totally
changed.
o the personal narrative and the picture description protocols will remain
unchanged
o the Cinderella story will be replaced by Capra cu trei iezi (The Goat and
Her Three Kids) written by Ion Creang;
o in the procedural discourse aphasic patients will be asked to describe how
they would prepare sarmale (cabbage rolls, stuffed cabbage) instead of
peanut butter and jelly sandwich;
o the Famous People Protocol will include personalities from Romania.