Aphasia History and Therapy - Chapter 2

Chapter 2: Significant Landmarks in the History of Aphasia and Its Therapy

• Objectives: The reader will understand the origins of aphasia classifications, compare models, appreciate social & political influences, identify key figures and events, understand treatment shifts, and where ideas about aphasia originated.
• Introduction: Ancient Egyptians considered the heart the seat of the soul; pre-Christian thought included fluid theories. Plato believed the mind was in the head, contrasting with Aristotle's view that it was in the heart. Early anatomical studies focused on the ventricles, not the substance of the brain. Early treatments for aphasia were based on the idea that it was a memory disorder.
• Ancient Past: The Edwin Smith Papyrus (5,000-4,200 BP) contains early references to "speechless" individuals, although the treatment was ineffective. Ancient Egyptian medicine didn't consider the brain important; the heart held more significance.
• Greco-Roman Period: A connection between cognitive processes and the brain emerged. Philosophers debated whether the mind was in the brain or heart. Plato's tripartite soul corresponded to anatomical regions; Aristotle argued that the heart hosted cognitive functions. The ventricular theory (cells) of the brain also emerged then and persisted for many centuries.
• Middle Ages: The ventricular theory persisted. Aphasia was associated with damage to the fourth ventricle.
• Renaissance to the 17th Century: Major advances in anatomy and physiology connected brain structure and function. Leonardo Da Vinci developed accurate anatomical sketches. Important figures like Andreas Vesalius and Thomas Willis challenged Galen's theory. Willis proposed that the cortex was crucial to mental functions and memory. Descartes' separation of mind and body influenced future understandings.
• 18th Century Enlightenment: Newton proposed a vibration theory. Locke viewed the mind as a collection point for sensory perceptions. Hartley linked sensory perceptions to memory using Newton's vibration theory.
• 19th Century: Localized damage to different areas of the brain correlated with particular language disturbances. Broca and Wernicke's work highlighted specific areas impacting speech and language comprehension, respectively. Concepts like amnesic aphasia and agrammatism (and paragrammatism) became increasingly understood. Other important figures include Pick, a psycholinguist who considered aphasia as a result of word and lexical impairment, and Jakobson, whose theories explored regressions of language acquisition.
• 20th Century: The devastation of WWI spurred significant developments. Luria, Goldstein, and other researchers focused on holistic brain function and treatment based on their findings. The development of functional systems. Other approaches emphasized speech gymnastics, auditory and repetition-based therapies. The 20th century also saw the evolution of more comprehensive and detailed testing for aphasia, including a transition toward a greater focus on patient experience through assessment strategies and therapies aimed to understand the specific needs of individual patients with different forms and severities of the disorder. In addition to the medical model, socially-based treatments emerged. EBP practices also gained traction in the latter half of the 20th century.

Chapter 3: Neurology, Connectivity, and the Nature of Aphasia

• Objectives: The reader will identify anatomical structures important for speech and language processing, understand how brain vascular systems support these, name different methods for studying the brain, relate different approaches and classifications for aphasia and understand brain connectivity and its role in recovery from language disorders.