Agrammatism: definition, causes, symptoms and treatment

The first three years of human life are key to the development and acquisition of speech and language skills. Skills that, in principle, will accompany the person during the rest of their lives.

But there are cases in which this capacity is truncated due to injuries in certain brain regions; appearing like this aphasic disorders that carry deficits such as agrammatism, which will be discussed throughout this article.

What is agrammatism?

Agrammatism is considered an alteration of the language typical of aphasias. Its most remarkable peculiarity is that the person presents a linguistic deficit which is shown by faults related to morphological structures. That is, it presents great difficulty in joining words in a sentence forming syntactically adequate sequences.

This failure usually appears in patients diagnosed with Broca's aphasia. The fact that it manifests as a difficulty in creating syntactic constructions makes it be considered one more symptom within this type of aphasia.

However, after the development of cognitive neuropsychology in the mid-twentieth century, it became clear that agrammatism was something much more complex and that could be observed in patients who do not respond to the rest of the requirements for the classic diagnosis of aphasia of Drill. In addition, the individual differences between the patients were more than remarkable.

At that very moment, an immense debate arose about whether agrammatism could be considered a validated aphasic category. This controversy still remains today, with disagreement between those who advocate agrammatism as an aphasic syndrome and those who oppose its validity as such.

But what are aphasias?

According to the general definition of aphasia, this refers to a language disorder caused by brain lesions in some of the areas of language, and that makes the person unable to communicate through speech, writing and even mime.

The causes of aphasia can be:

• Stroke
• Head trauma
• Brain infection
• Neoplasia
• Degenerative process

On the other hand, if we focus on the definition of Broca's aphasiaThis is characterized by the practical impossibility of achieving a fluent verbal production and by the use of short and grammatical sentences produced with enormous effort and in a prosodic way.

Symptoms

There are a series of symptoms that are shown more or less consistently in the understanding and production of agrammatic patients.

1. Symptoms associated with language production

These are the most common symptoms associated with speech.

1.1. Problems in grammatical morphemes

This symptom is reflected in the selective omission of both free and bound grammatical morphemes.. However, this symptom as such is more typical of English-speaking patients, who add inflections to the words. But in languages ​​like Spanish or Italian it is not possible, since the inflections are added to the roots.

For example, in English, -ed can be omitted from the word walk, but a language person Hispanic will not be able to omit -ía en comía, since it will no longer constitute a word but a sound without meaning.

Faced with this fact, the omission of free grammatical morphemes and the substitution or omission of grammatical morphemes linked according to the language were considered as characteristic of agrammatism.

1.2. Average length of sentence utterance

One of the symptoms observed in agrammatism, but not always present, is the reduced oral emission length. In which patients express themselves through expressions and phrases much shorter than usual.

1.3. Noun-verb dissociation

Another of the symptoms that people with agrammatism present is that of difficulty in accessing verb forms. That is, patients omit or nominalize the main verbs of the sentences.

This deficit occurs both in structured tasks and in spontaneous oral production tasks.

1.4. Difficulties in sentence construction

These patients use subject-verb-object structures; presenting an enormous difficulty in sentences of greater syntactic complexity. This symptom is the consequence of a lexical deficit that affects the correct selection of verbs.

1.5. Word ordering problems

It is considered one of the most characteristic features of agrammatism. Agrammatic patients have difficulties in correctly ordering verbal expressions according to an understandable order, especially in the production of passive phrases or with structures different from those usual.

2. Symptoms associated with linguistic comprehension

Until the 1970s, agrammatism was considered an exclusive deficit of language production, regardless of whether linguistic understanding was altered.

But research on the agrammatics' listening comprehension has revealed that these patients show difficulties in some specific syntactic components, which prevents them from understanding some sentence structures. It is specified that the alteration is selective since the patients present a great deterioration in the understanding of certain sentences, but the rest of the syntax remains intact.

Assessment and diagnosis

Despite the complexity of this deficit, there are no specific tests to evaluate it; being the tests of the evaluation of aphasia the most used.

At the moment, the subtests of the Boston and Barcelona tests concerning verbal expression are used: narration of an event and description of an image. The evaluation includes the transcription of the patient's speech with the subsequent evaluation of poverty vocabulary, the quality of the phrases, the incorrect use of morphemes and lexemes, or the incorporation of words functional.

1. Boston Aphasia Diagnostic Test (Goodlas and Kaplan, 1972)

It is the most widely used test given its ease of administration. It contains a specific vocabulary assessment test, and an abbreviated format for rapid patient screening.

2. Barcelona Test (Peña-Casanova, 1990)

This test assesses all cognitive mechanisms related to language. It is characterized by being an extensive and complicated test but it consists of an abbreviated format.

Treatment: HELPSS method

The beginnings of this method were based on certain studies of agrammatism, in which story completion techniques were used in patients with Broca's aphasia and agrammatics.

In addition, this method integrated different levels of difficulty to the story completion activities. Thus, the HELPSS methodology includes a succession of stages arranged hierarchically in two levels of difficulty: A and B; also working with eleven types of sentences:

• Transitive imperative
• Intransitive imperative
• Transitive declarative
• Pronominal interrogative
• Transitive declarative
• Declarative intransitive
• Comparative
• Passive
• Direct and indirect object
• Yes / no questions
• Subordinate clauses
• Future

Each type of sentence is worked on with both levels of difficulty, presenting twenty stories with different examples of the above sentence types, which are exemplified with images but not with phrases written.

During level A, the professional must tell a story that ends with the image of it. A question is then posed to the patient in order to obtain an answer from him by means of an example. When the person reaches 90% correct answers in a type of sentence, they go to level B of it.

During Level B, the example phrase is omitted; the patient having to elaborate the phrase genuinely.