Abstract
A theoretical framework which considers the verbal functions of the brain under a multivariate and comprehensive cognitive model was statistically analyzed. A confirmatory factor analysis was performed to verify whether some recognized aphasia constructs can be hierarchically integrated as latent factors from a homogenously verbal test. The Brief Aphasia Evaluation was used. A sample of 65 patients with left cerebral lesions, and two supplementary samples comprising 35 patients with right cerebral lesions and 30 healthy participants were studied. A model encompassing an all inclusive verbal organizer and two successive organizers was validated. The two last organizers were: three factors of comprehension, expression and a “complementary” verbal factor which included praxia, attention, and memory; followed by the individual (and correlated) factors of auditory comprehension, repetition, naming, speech, reading, writing, and the “complementary” factor. By following this approach all the patients fall inside the classification system; consequently, theoretical improvement is guaranteed.
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Notes
It is a common expression to say that a test measures certain neuropsychological functions. Yet, those functions are concepts which need to be empirically validated.
’A structural model with linear relations is only an approximation. The world is unlikely to be linear. Indeed, the true relations between variables are probably nonlinear. Moreover, many of the statistical assumptions are somewhat questionable as well. The real question is not so much, “Does the model fit perfectly?” but rather, “Does it fit well enough to be a useful approximation to reality, and a reasonable explanation of the trends in our data?’ (StatSoft, Inc., 2004).
Several models were proved (results available upon request). The model reported here was the one with the best fit according to the present validity index (see below).
Rejecting the hypothesis for each elementary contributor would imply that its value is not zero and should be included. The validity of the general model is, however, the defining criterion for inclusion (see above).
All significant pairwise comparisons were also confirmed with the non parametric test of Kruskal–Wallis ANOVA by Ranks, and a significance level of \(p<0.001\) (results available upon request).
When short tests have been well designed it is expected that patients show improvement even during the course of the evaluation. In the case of the BAE, some strategies were implemented trying to make the administration more pleasant. Some of these strategies are: the initial presentation of the test as a natural conversation, the attention to the rapport and to the minimal signs of patient’s distress, the ordering of the items by difficulty and by its appearance in ontogeny (from comprehension to expression), the possibility of skipping items, the presentation of the test as a fun interaction with permanent reinforcements to successful responses, and the standardization of the command repetitions to avoid the feeling of failure on the part of the patient.
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Acknowledgments
This study was supported by funds from the National Council of Scientific and Technological Research in Argentina (CONICET), from which Vigliecca is a researcher and Báez is a postgraduate fellow. We are grateful to Marisa Peñalva, Silvia Molina and Jorge Castillo for data collection and to Mónica Balzarini for her valuable comments.
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The authors stated that there are no conflicts of interest that could have inappropriately influenced the work submitted.
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Vigliecca, N.S., Báez, S. Verbal Neuropsychological Functions in Aphasia: An Integrative Model. J Psycholinguist Res 44, 715–732 (2015). https://doi.org/10.1007/s10936-014-9316-4
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DOI: https://doi.org/10.1007/s10936-014-9316-4