This article was downloaded by: [Simon Fraser University]

On: 01 February 2015, At: 12:53

Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954
Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Aphasiology
Publication details, including instructions for authors and
subscription information:
http://www.tandfonline.com/loi/paph20

Spontaneous evolution of aphasia

after ischaemic stroke
a a a a
M. Mazzoni , M. Vista , L. Pardossi , L. Avila , F.
b a
Bianchi & P. Moretti
a
Neuropsychology Laboratory , Institute of Clinical
Neurology, University of Pisa , Italy
b
Unit of Epidemiology and Biostatistics , Institute of Clinical
Physiology, CNR , Pisa, Italy
Published online: 29 May 2007.

To cite this article: M. Mazzoni , M. Vista , L. Pardossi , L. Avila , F. Bianchi & P. Moretti
(1992) Spontaneous evolution of aphasia after ischaemic stroke, Aphasiology, 6:4, 387-396,
DOI: 10.1080/02687039208248609

To link to this article: http://dx.doi.org/10.1080/02687039208248609

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information
(the “Content”) contained in the publications on our platform. However, Taylor
& Francis, our agents, and our licensors make no representations or warranties
whatsoever as to the accuracy, completeness, or suitability for any purpose of the
Content. Any opinions and views expressed in this publication are the opinions and
views of the authors, and are not the views of or endorsed by Taylor & Francis. The
accuracy of the Content should not be relied upon and should be independently
verified with primary sources of information. Taylor and Francis shall not be liable
for any losses, actions, claims, proceedings, demands, costs, expenses, damages,
and other liabilities whatsoever or howsoever caused arising directly or indirectly in
connection with, in relation to or arising out of the use of the Content.

This article may be used for research, teaching, and private study purposes. Any
substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,
systematic supply, or distribution in any form to anyone is expressly forbidden.
Terms & Conditions of access and use can be found at http://www.tandfonline.com/
page/terms-and-conditions
 APHASIOLOGY, 1992, VOI,. 6, NO. 4, 387-396

Spontaneous evolution of aphasia after

ischaemic stroke

M. M A Z Z O N I , M . V I S T A , L. P A R D O S S I , L.
A V I L A , F;. B I A N C H I t a n d P . M O R E T T I

Neuropsychology Laboratory, Institute of Clinical Neurology, University of

Pisa, Italy

t u n i t of Epidemiology and Biostatistics, Institute of Clinical Physiology,

CNR, F’isa, Italy
Downloaded by [Simon Fraser University] at 12:53 01 February 2015

Abstract
The relatively few studies concerning spontaneous recovery from aphasia yield
contradictory findings because of the large number of influencing factors. We
have assessed a selected sample of 45 patients, none of whom received
language therapy, in order to determine such patients’ chances of spontaneous
recovery in relation to type and severity of aphasia and size of lesion. Our
results show comprehension to have the best recovery, independent of type
and severity of aphasia. Expression shows a lower recovery, especially for
non-fluent ap:hasics; their performance is also negatively influenced by oral
apraxia. In addition, the overall severity of aphasia, associated with large
lesions, is a negative prognostic factor for recovery of expression.

Introduction
The assessment of spontaneous recovery from aphasia is of both socioeconomic
and scientific importance. The former because being able to predict the evolution
of aphasia would facilitate the selection of patients for treatment; the latter
because, without this knowledge, results concerning the effectiveness of language
therapy could be obscured by the inclusion of subjects who would, in any case,
make a good recovery.
The relatively few studies available on spontaneous recovery from aphasia offer
contradictory findings, probably due the numerous factors involved (age,
education, sex, type and severity of aphasia, associated deficits, aetiology, site and
size of lesions) and to the wide variety of methods adopted by the investigators. In
some studies, for example, no distinction is made between aphasia and dysarthria
(Wade et al. 1986, Einderby et al. 1987); further, aphasics with different
aetiologes-brain injury, ischaemic and haemorrhagic stroke-have been
included in the same sample (Hartman 1981, Lendrem and Lincoln 1985, Wade et
al. 1986, Enderby et al. 1987, Pashek and Holland 1988). In addition, the absence
of neuroradiological findings often prevents careful correlation between the type
and severity of aphasia and aetiology, number and size of lesions (Kertesz and
McCabe 1977, Hartman 1981, Lendrem and Lincoln 1985, Wade et al. 1986,
Enderby et al 1987:).

Address correspondence to: M. Mazzoni, Istituto di Clinica Neurologca, via Roma 67, 56126,
Pisa, Italy.

0268-7038192 $3.00.0 1992 Taylor & Francis Ltd.

 388 M . Mazzoni et al.

Our aim was to reduce the number of variables involved in evaluating the
spontaneous recovery of language in the first 7 months post-onset, in aphasic
patients with a single ischaemic lesion. We assessed type and severity of aphasia
and size of lesion, which are identified in the literature as the main factors
influencing recovery from aphasia.

Method
Forty-five patients admitted for cerebrovascular disease to the Institute of Clinical
Neurology of Pisa University, between 1988 and 1990, were investigated.
All the patients included in the study met the following criteria: (1) they were
under 80 years of age; (2) had had at least 3 years of schooling; (3) were
right-handed starting from decile 5 R on the Edinburgh Inventory (Oldfield
1971); (4) were first-time stroke patients; (5) presented with aphasia which
Downloaded by [Simon Fraser University] at 12:53 01 February 2015

persisted after 15 days post-onset; (6) had a single ischaemic lesion of the left
hemisphere as revealed by cranial CT scan. Subject’s data are shown in Table 1.
The initial language examination was performed 15 days post-onset (TO), and
this was followed by re-evaluations at 1 month (Tl), 3-4 months (T2) and 6-7
months (T3). During this entire time, patients were not submitted to language
rehabilitation because of problems-familial or logstic-which precluded regular
attendance at rehabilitation facilities.
The type of aphasia, fluent or non-fluent, was evaluated according to the
criteria of Goodglass et al. (1964). The aphasic disorder was assessed using the
language examination described by Basso et al. (1979), consisting of subtests which
explore oral expression, auditory verbal comprehension, written expression and
reading comprehension. These modalities have been considered improved when
scores, ranging from 0 (no communication) to 4 (very good communication),
increased by at least 1 point. The overall severity of aphasia was assessed at the first
examination. Using the definition of Basso et al. (1979), patients who scored 0 to
1 on the oral expression and 0 to 2 on auditory verbal comprehension subtests
were defined as severe aphasics; those who obtained a score of 0 to 3 on oral
expression and 3 to 4 on auditory verbal comprehension were defined as
moderate aphasics.
Non-fluent patients were also submitted to the oral apraxia test described and
employed by De Renzi et d.(1966).
The mapping of lesions from cranial CT scans was performed using Mazzocchi
and Vignolo’s method (1979), in order to obtain a crude measure of the cortical
extension of the injured areas (in mm2).
The analysis of the age distribution according to the type (fluent vs non-fluent)
and severity of aphasia was performed by means of Student’s t-test (age), and by
the chi-square test when sex and education were considered (Armitage 1971).
Scores attributed to the repeated measures of oral expression, auditory verbal
comprehension, written expression and reading comprehension, in relation to
each of the aphasia variables, were analysed by means of non-parametric methods,
because of lack of normality in the probability distribution of the scores.
The overall progression in mean scores obtained throughout the 7 months
post-onset was analysed using the Friedman ANOVA method (x*), and the
Wilcoxon test (z) was used in order to compare the difference between pairs of
time intervals (Siege1 1956).
 Spontaneous evolution in aphasia 389

Table 1. Patient's personal data and aphasic characteristics

Aphasia Size of lesion

Name Age Sex Education Type Severity mm2 Category

1 LL 69 M 8 NF M 66 1 S
2 PA 6.1 M 5 NF M 300 S
3 SA* 71 M 5 NF S 3067 L
4 GD 50 M 5 NF M 797 S
5 NE* 7.3 M 17 NF S 2693 L
6 BM* 6.1 F 5 NF S 5165 L
7 MM* 5'3 F 5 NF S 3250 L
8 NS* 615 M 5 NF S 3408 L
9 PA* 7.5 M 5 NF S 2382 M
10 PV* 46 F 3 NF S 6268 L
Downloaded by [Simon Fraser University] at 12:53 01 February 2015

11 MS* 69 F 5 NF S 2270 M
12 SS 66 M 5 NF S 2480 M
13 SF 613 M 5 NF S 2849 L
14 VL* 68 F 5 NF S 3358 L
15 MA* 61 M 5 NF S 4483 L
16 GE 71 F 5 NF S 2495 M
17 SR* 64 F 5 NF M 1849 M
18 FAL 66 M 5 NF S 7738 L
19 VG 65 M 5 NF M 279 S
20 BL 48 M 10 NF M 986 S
21 BE 77 M 6 NF M 710 S
22 SG 74 M 5 NF M 1242 S
23 FF 71 M 3 NF M 614 S
24 NE 71 M 4 F S 5151 L
25 CG 74 F 3 F S 1656 M
26 TD 68 F 5 F S 4435 L
27 DA 76 F 6 F S 1851 M
28 MF 64 M 8 F S 6090 L
29 PE 75 M 3 F S 2385 M
30 DE 66 M 8 F M 666 S
31 vs 63 F 5 F M 697 S
32 IM 613 M 5 F S 1028 S
33 MN 63 M 8 F M 2857 L
34 FL 615 M 5 F S 2214 M
35 ME 6'7 M 5 F S 3898 L
36 CA 75 F 6 F S 1705 M
37 RR 7'1 M 5 F M 461 S
38 GO 72 M 5 F M 430 S
39 AS 69 M 11 F M 843 S
40 BI 63 M 5 F M 1447 M
41 CP 73 M 5 F M 1613 M
42 RL 75 M 5 F M 1405 M
43 CIA 79 M 6 F M 2098 M
44 CRD 5'7 F 5 F M 1320 S
45 MV 62 M 5 F M 5586 L

Sex: M=male; F=female:, type: NF=non-fluent; F=fluent; severity: M=moderate; S=severe; size of lesion:
S=small; Mzmedium; L:=Large,*: oral apraxia

The analyses were performed using the BMPD computer package (Dixon
1983).
 390 M . M a z z o n i et al.

Results
Subjects’ personal data and aphasic characteristics are presented in Table 1.
Individual language modality scores from each of the four examination sessions
(TO, T1, T2, T3) are reported in Table 2.

Language recovery in relation to type ofaphasia

Twenty-two patients were classified as fluent and 23 as non-fluent, according to
the criteria of Goodglass et al. (1964). Their distribution in these two groups was
found to be random for age, sex and education level. Figure 1 shows the
progression of mean subtest scores for the four modalities examined.
During the 7 months post-onset, fluent patients improved significantly in all
four modalities. The recovery of oral expression and written expression progressed
Downloaded by [Simon Fraser University] at 12:53 01 February 2015

steadily over time, whereas auditory verbal comprehension improved only within
the first 4 months and reading comprehension only within the first month.
On the other hand, non-fluent patients showed significant improvement in
auditory verbal comprehension and, to a lesser extent, in oral expression, but no
significant changes were seen in the modalities involving written language.
Analysis of recovery made within the time intervals studied showed improvement
between TO and T1 in reading comprehension, and between T1 and T2 in oral
expression and written expression. The recovery of auditory verbal
comprehension progressed more uniformly, and was significant throughout the
first 4 months post-stroke.
Within the group of non-fluent aphasics the possible influence of oral apraxia
(OA) on the recovery of oral expression was assessed: 12 patients without OA
improved significantly (p<O.Ol), whereas 11 patients with OA did not show any
improvement.

Language recovery in relation to severity o f aphasia on j r s t examination

According to the criteria of Basso et af. (1979), our sample consisted of 21 patients
classified as moderate aphasics and 24 as severe. Their distribution in these two
groups was found to be random for age, sex and level of education. The pattern of
recovery in each group, for the four language modalities examined is shown in
Figure 2.
Within the group of moderate aphasics, both oral expression and written
expression improved uniformly and significantly throughout the entire time of
observation. Auditory verbal comprehension and reading comprehension showed
no significant improvement because these modalities started from nearly normal
scores; even so, an improvement was seen between TO and T1.
In contrast, severe aphasics exhibited different features: only auditory verbal
comprehension and, to a lesser extent, reading comprehension improved
significantly. No significant recovery was observed in oral expression or written
expression, although the latter showed a modest improvement between T1 and
T2.

Language recovery in relation to size of lesion

Finally, the sample was divided into three groups on the basis of lesion size (small:
 Spontaneous evolution in aphasia 391

Table 2. Language modality score from successive testing sessions, TO, T1, T2, T3

Oral expression Auditory verbal Written expression Reading

comprehension comprehension
Name TO TI T2 T3 TO T1 T2 T 3 TO T1 T2 T3 TO T1 T2 T 3

1 LL 2 2 3 3 4 4 4 4 2 2 4 4 4 4 4 4
2 PA 2 2 3 3 4 4 4 4 2 2 4 4 4 4 4 4
3 SA 0 0 0 0 2 4 4 4 0 0 0 0 3 4 4 4
4 GD 2 2 4 4 4 4 4 4 1 2 3 3 4 4 4 4
5 NE 0 0 0 0 2 4 4 4 0 0 0 0 0 4 4 4
6 BM 0 0 0 0 0 1 2 3 0 0 0 0 0 0 1 0
7 MM 0 0 0 0 0 2 4 4 0 0 0 0 0 0 0 0
8 NS 0 0 0 0 0 0 1 3 0 0 0 0 0 0 0 0
9 PA 0 0 0 0 0 0 2 2 0 0 0 0 0 0 0 0
10 PV 0 0 0 0 0 3 4 4 0 0 0 0 0 0 0 0
Downloaded by [Simon Fraser University] at 12:53 01 February 2015

11 MS 0 1 2 2 2 4 4 4 0 0 1 1 1 4 4 4
12 ss 0 1 1 1 2 4 4 4 0 0 0 0 1 4 4 4
13 SF 0 0 0 0 1 2 2 3 0 0 1 1 1 2 2 2
14 VL 0 0 0 0 0 1 2 3 0 0 0 0 0 0 0 0
15 MA 0 0 0 0 0 2 4 4 0 0 0 0 0 0 0 0
16 GE 0 0 0 0 0 2 3 3 0 0 0 0 0 0 0 0
17 SR 0 0 1 1 4 4 4 4 0 0 0 0 0 1 1 1
18 FAL 0 0 0 0 0 2 2 2 0 0 0 0 0 0 0 1
19 VG 2 2 2 3 3 3 4 4 2 2 2 2 3 3 4 4
20 BL 2 2 3 3 4 4 4 4 0 2 3 3 4 4 4 4
21 BE 2 3 3 4 3 4 4 4 3 3 4 4 3 4 4 4
22 SG 2 3 3 3 3 4 4 4 2 3 3 3 4 4 4 4
23 FF 2 2 3 3 4 4 4 4 2 2 3 4 4 4 4 4
24 NE 0 0 0 0 0 2 3 3 0 0 0 0 0 0 1 1
25 CG 0 0 0 0 0 1 2 2 0 0 0 0 0 1 1 1
26 TD 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 1
27 DA 0 0 0 0 0 2 4 4 0 0 0 0 0 0 1 1
28 MF 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 PE 0 0 0 0 1 3 4 4 0 0 0 0 0 0 1 1
30 DE 2 3 4 4 4 4 4 4 2 2 3 3 3 4 4 4
31 vs 2 3 2 3 3 4 4 4 1 2 2 3 3 4 4 4
32 IM 0 0 1 2 2 4 4 4 0 0 1 1 1 2 3 3
33 MN 1 2 3 3 3 4 4 4 0 2 2 3 2 4 4 4
34 FL 0 0 0 1 2 2 4 4 0 0 0 0 2 4 4 4
35 ME 0 1 2 2 0 3 4 4 0 0 0 0 0 0 0 0
36 CA 0 0 2 3 2 4 4 4 0 0 1 1 0 2 3 3
37 RR 2 3 3 3 4 4 4 4 1 2 2 3 4 4 4 4
38 GO 2 2 3 3 4 4 4 4 1 2 2 2 4 4 4 4
39 AS I 1 1 2 3 4 4 4 0 0 1 1 4 4 4 4
40 BI 2 3 4 4 4 4 4 4 2 3 4 4 4 4 4 4
41 CP 2 3 4 4 4 4 4 4 0 2 3 4 4 4 4 4
42 RL 2 4 4 4 4 4 4 4 2 4 4 4 4 4 4 4
43 CIA 2 2 2 4 2 4 4 4 1 2 2 3 2 4 4 4
44 CRD 2 3 3 4 2 4 4 4 0 0 1 1 2 4 4 4
45 MV 2 2 3 2 3 4 4 4 1 1 2 2 3 4 3 4

0-1400 mm2; medium: 1400-2500 mm2; large: >2500 mm2; see Figure 3 ) .
Patients were found to be randomly distributed for sex and level of education;
however, patients with lesions of medium size were older than the other groups
(pC0.05).
 392 M . Mazzoni et al.
ORAL EXPRESSION AUDITORY VERBAL
COMPREHENSION
4 1

-0
10 I1 12 13 10 11 12 13

WRITTEN EXPRESSION READING COMPREHENSION

‘1 4~

31
Downloaded by [Simon Fraser University] at 12:53 01 February 2015

- 0
ID I1 12 13

Figure 1. Fluent ( 0) and non-fluent ( ) aphasias: the evolution of the four language modalities as
represented by mean subtest scores in the two subgroups (Wilcoxon’s test yielded *p<O.O5; Friedman’s test

:?:::I:“ ;p**
yielded *p<0.05; **p<O.Ol; ***p<O.OOl).

ORAL EXPRESSION AUDITORY VERBAL

COMPREHENSION

5:
0
10 11 12 13 10 11 12 13

WRITTEN EXPRESSION READING COMPREHENSION

ii:
0
to I1 12 I3 I0 I1 12 13

Figure 2. Moderate ( ) and severe ( ) aphasias: the evolution of the four language modalities as
represented by mean subtest scores in these two subgroups (Wilcoxon’s test yielded *p<0.05; Friedman’s,
test yielded *p<0.05, **p<O.Ol; ***p<O.OOl).

In relation to small lesions, there was a highly significant recovery of both oral
and written expression, which progressed most notably between T1 and T2.
Comprehension, both oral and written, remained unchanged because scores were
nearly normal at TO.
Aphasics with medium-sized Iesions improved significantly in all the modalities
except written expression. The greatest amount of recovery was found between
TO and T1.
 Spontaneous evolution in aphasia 393

ORAL EXPRESSION AUDITORY VERBAL

COMPREHENSION
4 1

10 11 12 13 10 tl 12 13

WRITTEN EXPRESSION READ1NG COMPREHENSION

4
Downloaded by [Simon Fraser University] at 12:53 01 February 2015

I0 11 12 13 10 11 12 13

+
Figure 3. Aphasias ch.aracterizedby small ( ), and medium ( 11 ) and large ( ) lesions: the evolution
of the four language modaliti,es as represented by patients’ mean subtest scores in these three subgroups
(Wilcoxon’s test yielded *p<0.05; Friedman’s test yielded *p<0.05; **p<O.Ol; ***p<O.OOl).

Only auditory verbal comprehension showed a significant improvement in the

group with large lesions; the recovery was especially marked between TO and T1.

Discussion
Aphasia is a dynamic disorder that improves with time when it is not due to
progressive aetiology, and recovery in comprehension modalities exceeds that of
expressive modalities (Basso 1990). Therefore, the better recovery of
comprehension seen in our results is in agreement with other studies (Vignolo
1964, Lomas and Kertesz 1978, Basso et al. 1979, Demeurisse et al. 1980). In
particular auditory verbal comprehension improved independently of type and
severity of aphasia and size of lesion. The improvement is early (first 3-4 months
post-onset) and remarkable; so severe aphasics, who started from a mean score of
0.5 at TO, scored 3 ,at T3. On the other hand, improvement in reading
comprehension was less overall, and restricted to the first month post-stroke.
There are three possible reasons for comprehension recovering better than
expression:
1. Comprehension is ‘less difficult’ than expression (Prins et al. 1978). Indeed, a
hearer has the much more restricted task of interpreting ready-made linguistic
structures, whereas a speaker must himself or herself plan what he or she is
going to say, select lexical items and apply syntactic rules.
2. Comprehension is ‘trained’ daily in a non-specific and effective way: aphasics
live with speakmg people in a context which acts as support (Basso 1977).
Comprehension needs not only syntactic-lexical decoding operations, but
also helpful contextualization in order to generate inferences, to draw
deductions and to compare input messages to actual knowledge (Carlomagno
1989). Stachowiack ef al. (1977) pointed out poorer performance by aphasics
 394 M . Mazzoni et al.

on a comprehension task of single sentences in comparison with controls,

whereas comprehension of short texts showed no differences. Probably the
redundancy of information in a text-or in conversation-facilitates
comprehension by aphasics. Thus Gardner et al. (1975) concluded that
aphasics improve their performance in a word comprehension task if words
are presented in a semantic-lexical context.
3. The non-dominant hemisphere has good comprehension capacity, as
demonstrated in callosectomized patients (Gazzaniga and Sperry 1967) and
dominant hemispherectomized patients (Zollinger 1935, Crockett and
Estridge 1951, Smith 1966, Gott 1973). Therefore, Wapner et al. (1981)
suggested its important role in processing complex linguistic entities
dependent upon context.

The right hemisphere could play a determining role in comprehension recovery,

Downloaded by [Simon Fraser University] at 12:53 01 February 2015

as demonstrated by patients with total or sub-total left injury who retained

sufficient capabilities of comprehension, but who lost them after a later stroke in
the right hemisphere (Nielsen 1946, Lhermitte et al. 1973, Levine and Mohr
1979, Cambier et al. 1983).
O n the other hand oral and written expression show scanty evolution,
especially in severe aphasias or those characterized by large lesions. Severity of
aphasia is considered an important prognostic factor: severe aphasics do not
improve in expression, although they do show the usual remarkable recovery in
comprehension (Sands et al. 1969, Prins et al. 1978, Basso et al. 1979, Pickersgill
and Lincoln 1983, Lendrem and Lincoln 1985). Our results are in agreement with
other data in the literature, showing a recovery of expression for moderate
aphasics only.
Size of lesion seems to correlate with aphasia severity and a poor outcome for
oral and written expression and reading comprehension. Auditory verbal
comprehension shows a significant recovery independent of size of lesion,
supporting the above hypothesis. Studies performed with computerized
tomography (CT) scans support these data, pointing to size of lesion as responsible
for aphasia severity (Yarnell et al. 1976, Mohr et al. 1978, Basso et al. 1980,
Brunner et al. 1982, Knopman et al. 1983, 1984, Selnes et al. 1983, Ludlow et al.
1986, Naeser et d.1987).
Spontaneous recovery could be negatively influenced by a larger lesion:
indeed, wide injury of language areas interferes with their functiondl
reorganization, and recovery could then be supported only by the non-dominant
hemisphere, which has a good capacity for comprehension, but a poor one for
expression. If lesions are small, unaffected left hemisphere areas could play an
important role, determining a greater quality and quantity of recovery (Levine and
Mohr 1979).
In our study comprehension recovery was evident from the first examination
onward, both in fluent and non-fluent patients, similar to other data reported in
the literature (Prins et al. 1978, Pickersgill and Lincoln 1983). A different recovery
pattern was revealed for expression: improvement was significant from TO for
fluent aphasics, and was maintained uniformly, whereas recovery was significant
only between T1 and T2 for non-fluent patients. Oral apraxia could be
responsible for the reduced recovery of expression by non-fluent aphasics, as
previously stressed by Vignolo (1964) and Basso et al. (1979) regarding patients
 Spontaneous evolution in aphasia 395

with anarthria and oral apraxia. Our findmgs confirm its negative influence:
recovery is statistically significant for patients without oral apraxia, but
insignificant in the apractic ones.

References
ARMITAGE, J. (1971) Statistical Methods in Medical Research (Blackwell, Oxford).
BASSO,A. (1977) Il paziente afhsico (Feltrinelli, Milano).
BASSO,A. (1990) Valutazione, recupero e terapia dell'afasia. In G. Deries and L. Pizzamiglio (Eds)
Manuale di neuropsicologia. (Zanichelli, Bologna).
BASSO,A,, CAPITANI, €1. and 'VIGNOLO, L. A. (1979) Influence of rehabilitation on language slulls in
aphasic patients. Archives of Neurology, 36, 190-196.
BASSO,A., CAPITA",E., LAIACONA, M. and LUZZATTI,C. (1980) Factors influencing type and
Downloaded by [Simon Fraser University] at 12:53 01 February 2015

severity of aphasia. Cortex, 16, 631-636.

BRUNNER,R. J., KORNHUBEIR, H. H., SEEMULLER, E., SUGER,G. and WALLESCH, C-W. (1982)
Basal ganglia partecipation in language pathology. Brain and Language, 16, 281-299.
CAMBIER,J., ELGHOZI,D., SIGNORET, J. L. and HENIN,D. (1983) Contribution de l'hemisphere
droit au langage des aphasiques. Disparition de ce langage apres lesion droite. Revue
Neurologique, 13!P, 55-63.
CARLOMAGNO, S. (1989) Pragmatica della comunicazione e terapia dell'ajasia (Masson, Milano).
CROCKETT,H. G. and ESTRIDGE, N. M. (1951) Cerebral hemispherectomy. Bulletin o f h s Angeles
Neurologic Society, 16, 71-87.
DEMEURISSE, G., DEMOL,O., DEROUCK, M., DE BEUCKELAER, R., COEKAERTS, M. J. and CAPON,
A. (1980) Quantitative study of the rate of recovery from aphasia due to ischemic stroke.
Stroke, 11, 455-458.
DE RENZI,E., PIECZURO, A. :and VIGNOLO, L. A. (1966) Oral apraxia and aphasia. Cortex, 2, 50-73.
DIXON,W. J. (1983) B M P D Statistical Sojware, 1983 Printing with Additions. PZV-Analysis of Variance
and Covariance including repeated measures (California Press, University of Los Angeles).
ENDERBY, P., WOOD,'if.A., WADE,D. T. and HEWER,R. L. (1987) Aphasia after stroke: a detailed
study of recovery in thlt first 3 months. International Rehabilitation Medicine, 8, 162-165.
GARDNER,H., ALBERT,M. L. and WEINTRAUB, S. (1975) Comprehending a word: the influence of
speed and redundancy 'on auditory comprehension in aphasia. Cortex, 11, 155-162.
GAZZANIGA, M. S. and SPERFIY, R . W . (1967) Language after section of the cerebral commissures.
Brain, 90, 131-148.
GOODGLASS, H., QUADFASEL, F. A. and TIMBERLAKE, W . H. (1964) Phrase length and the type and
severity of aphasia. Cortex, 1, 133-153.
GOTT, P. S. (1973) Language after dominant hemispherectomy. Journal of Neurology, Neurosurgery and
Psychiatry, 36, 1082-1088.
HARTMAN, J. (1981) Measurement of early spontaneous recovery from aphasia with stroke. Annals of
Neurology, 9, 89--91.
KERTESZ,A. and MCCABE,P. (1977) Recovery patterns and prognosis in aphasia. Brain, 100, 1-18.
KNOPMAN, D. S., SELNES, 0. A., NICCUM,N., RUBENS, A. B., YOCK,I). and LARSON,D. (1983) A
longitudinal study of speech fluency in aphasia: CT correlates of recovery and persistent
nonfluency. Neclwology, 33, 1170-1 178.
KNOPMAN, D. S., SELP'IES, 0. A,, NICCUM,N. and RUBENS,A. B. (1984) Recovery of naming in
aphasia. Relationship to fluency, comprehension and C'r findmgs. Neurology, 34, 1461-1470.
LENDREM, W . and LINCOLN, N. B. (1985) Spontaneous recovery of language in patients with aphasia
between 4 and 34 wceks after stroke. Journal of Neurology, Neurosurgery and Psychiatry, 48,
743-748.
LEVINE,D. N. and MOHR,J. P. (1979) Language after bilateral cerebral infarctions: role of the minor
hemisphere in speech. Neurology, 29, 927-938.
LHERMITTE, F., LECOUliS, A. R., DUCARNE,B. and ESCOUROI.LE, R. (1973) Unexpected anatomical
findings in a case of fluent jargon aphasia. Cortex, 9, 436-449.
LOMAS,J. and KERTESZ, A. (1978) Patterns of spontaneous recovery in aphasic groups: a study of
adult stroke patients. Brain and Language, 24, 41 1-423.
LUDLOW,C. L., ROSE~BERG, J., FAIR,C., BUCK,D., SCHESSELMAN, S. and SALAZAR, A. (1986) Brain
 396 M . Mazzoni et al.

lesions associated with nonfluent aphasia fifteen years following penetrating head injury. Brain,
109, 55-80.
MAZZOCCHI, F. and VIGNOLO, L. A. (1979) Localisation of lesions in aphasia: clinical-CT scan
correlations in stroke patients. Cortex, 15, 627-654.
MOHR,J. P., PESSIN, M. S., FINKELSTEIN, S., FUNKENSTEIN, H. H., DUNCAN, J. W., DAVIS,K. R.
(1978) Broca aphasia: patological and clinical. Neurology, 28, 31 1-324.
NAESER,A. M., HELM-ESTABROOKS, N., HAAS,G., AUEKBACH, S. and SRINIVASAN, M. (1987)
Relationship between lesion extent in ‘Wernicke’s area’ on computed tomographic scan and
predicting recovery of comprehension in Wernicke’s aphasia. Archives OfNeurology, 44, 73-82.
NIELSEN,J. M. (1946) Agnosia, Apraxia, Aphasia (Hoebner, New York).
OLDFIELD, R. C. (1971) The assessment of analysis of handedness: the Edinburgh Inventory.
Neuropsychologia, 9, 97-102.
PASHEK, G. V. and HOLLAND, A. L. (1988) Evolution of aphasia in the first year post-onset. Cortex,
24,411-423.
PICKERSGILL, M. J. and LINCOLN, N. B. (1983) Prognostic indicators and the pattern of recovery of
communication in aphasic stroke patients. Journal .f Neurology, Neurosurgery and Psychiatry, 46,
Downloaded by [Simon Fraser University] at 12:53 01 February 2015

130-139.
PRINS,R. S., SNOW,C. E. and WAGENAAK, E. (1978) Recovery from aphasia: spontaneous speech
versus language comprehension. Brain and Language, 6, 192-21 1.
SANDS,E. S., SARNO,M. T. and SHANKWEILER, D. P. (1969) Long term assessment of language
function in aphasia due to stroke. Archives of Physical Medicine and Rehabilitation, 50, 202-207.
SELNES,0. A., KNOPMAN, D. S., NICCUM,N., RUBENS, A. B. and LARSON,D. (1983) Computed
‘tomographic scan correlates of auditory comprehension deficits in aphasia: a prospective
recovery study. Annales .fNeurology, 13, 558-566.
S. S. (1956) Nonparametric Statisticsfor the Behavionral Sciences (McGraw-Hill, New York).
SEIGEL,
SMITH,A. (1966) Speech and other functions after left (dominant) hemispherectomy. Journal .f
Neurology, Neurosurgery and Psychiatry, 29, 467-471.
STACHOWIACK, F., HUBER,W., POECK,K. and KERSCHENSTEINER, M. (1977) Text comprehension
in aphasia. Brain and Language, 4, 177-195.
VIGNOLO, L. A. (1964) Evolution of aphasia and language rehabilitation: a retrospective exploratory
study. Cortex, 1, 344-367.
WADE,D. T., HEWER,R. L., DAVID,R. M. and ENDERBY, P. (1986) Aphasia after stroke: natural
history and associated deficits.Journal of Neurology, Neurosurgery and Psychiatry, 49, 11-1 6.
WAPNER,W., HMY, S. and GARDNER,H. (1981) The role of the right hemisphere in the
apprehension of complex linguistic materials. Brain and Language, 14, 15-33.
YARNELL,P., MONROE, P. and SOBEL,L. (1976) Aphasia outcome in stroke: a clinical
neuroradiologcal correlation. Stroke, 7, 516-522.
ZOLLINGER, R. (1935) Removal of left cerebral hemisphere. Report of a case. Archives of Neurology
and Psychiatry, 34, 1055-1064.