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PubMed2004

The neuropsychology of narrative: story comprehension, story production and their interrelation.

Stories are used extensively for human communication; both the comprehension and production of oral and written narratives constitute a fundamental part of our experience. While study of this topic has largely been the domain of cognitive psychology, neuroscience has also made progress in uncovering the processes underlying these abilities. In an attempt to synthesize work from both literatures, this review: (1) summarizes the current neuroimaging and patient research pertaining to narrative comprehension and production, (2) attempts to integrate this information with the processes described by the discourse models of cognitive psychology, and (3) uses this information to examine the possible interrelation between comprehension and production. Story comprehension appears to entail a network of frontal, temporal and cingulate areas that support working-memory and theory-of-mind processes. The specific functions associated with these areas are congruent with the processes proposed by cognitive models of comprehension. Moreover, these same areas appear necessary for story production, and the causal-temporal ordering of selected information may partially account for this common ground. A basic description of comprehension and production based solely on neuropsychological evidence is presented to complement current cognitive models, and a number of avenues for future research are suggested.

Cognition↗

PubMed2004

Comprehension of spatial language terms in Williams syndrome: evidence for an interaction between domains of strength and weakness.

Individuals with Williams syndrome show an unusual neuropsychological profile, with relatively strong language abilities and impoverished visual and spatial abilities. Two studies are reported that examine the interaction between these two domains in Williams syndrome by assessing individuals' comprehension of spoken language with a spatial component. In a first study, the Test for Reception of Grammar (Bishop, 1983) was given to 32 individuals with Williams syndrome and to controls matched individually for total number of errors on the task. Individuals with Williams syndrome had particular problems when asked to comprehend sentences containing spatial prepositions, making significantly more errors on these items than control groups. A second study examined in more detail comprehension of sentences with spatial and non-spatial components, comparing the performance of 15 individuals with Williams syndrome and control groups matched for vocabulary ability. Individuals with Williams syndrome again showed impaired comprehension of spoken spatial terms. In contrast, they were unimpaired in comprehending utterances without a spatial component, with the exception of descriptions testing comprehension of non-spatial comparatives (lighter than and darker than). These results suggest that the spatial difficulties experienced by individuals with Williams syndrome may constrain language comprehension in certain circumstances. They also shed light on the ways in which spatial cognition may interact with language comprehension more generally.

Adolescent↗

PubMed1982

Auditory language comprehension in aphasia: a factor-analytic study.

A battery of nine auditory comprehension test, taken by seventy aphasics, was subjected to a factor analysis. Two factors, interpretable respectively as a lexical semantic and a syntactic comprehension factor, were obtained. Comprehension described in terms of these factors was found to be related to criterion variables of importance, namely the Token Test and a rating of comprehension in daily life. Broca's aphasics were found to be more impaired in syntactic than in lexical semantic comprehension; Wernicke patients tended to have low scores on both factors. The results of this study support the view of independent lexically based and syntactic processing in auditory comprehension which can be differentially disrupted by brain damage.

Adult↗

PubMed2003

Does morphology make the difference? Agrammatic sentence comprehension in German.

This study examines the syntactic comprehension of seven German agrammatic speakers. The German language allows the study of the interaction of syntactic principles and morphological devices in the comprehension process. In addition, due to its relatively free word order, German allows the study of strictly minimal pairs of canonical and non-canonical sentences in addition to the rather controversial active-passive contrast. A central research question was whether the pattern of agrammatic comprehension predicted by the trace deletion hypothesis (TDH, Grodzinsky, 1990, 1995), relatively normal comprehension performance of canonical sentences and chance performance on non-canonical sentences, can be found in a language with richer morphology than English. The generalisability of the TDH-pattern to morphologically rich languages is not obvious, given that case morphology in particular can provide explicit cues to the detection of the agent and patient roles in a sentence. The results of this study indicate that morphology does not make a difference. Furthermore, the group results are in line with the TDH-predictions only for number marked sentences but not for case marked sentences. However, single case analysis reveals different patterns of syntactic comprehension in agrammatic patients, a spectrum that encompasses near-normal comprehension of canonical and non-canonical sentences, overall chance performance, and TDH-like profiles.

Adult↗

PubMed1999

Utility of comprehensive toxicologic screens in children.

This study was undertaken to evaluate the clinical utility and cost-effectiveness of the limited component versus the high performance liquid chromatography (HPLC) component of comprehensive toxicologic screens in children. A retrospective patient series was studied at the emergency department (ED) of Hughes Spalding Children's Hospital, an urban, tertiary-care ED, consisting of all patients younger than 19 years of age who had a comprehensive toxicologic screen between January 1994 and July 1995. The comprehensive test included a broad-spectrum HPLC component as well as a limited component that examined serum for ethanol, aspirin, and acetaminophen and urine for benzodiazepines, barbiturates, amphetamines, cocaine, phencyclidine, and opiates. All toxicologic screens were reviewed for the presence of exogenous toxins, followed by a chart review of all patients with positive screens and a selection of negative screens. Toxins were categorized as (1) iatrogenic or noniatrogenic, (2) clinically or nonclinically suspected by history and physical, and (3) clinically or nonclinically significant. Comprehensive toxicology screens were performed in 463 cases during the study period; 234 (51%) were positive for exogenous toxins. In 227 of 234 positive screens (97%), toxins were either suspected by history and/or physical, were present on the limited portion of the toxicology screen, or were clinically insignificant. The remaining 7 of the 234 positive screens (3%) were clinically significant and detected solely by the broad-spectrum HPLC portion of the comprehensive screen. However, in none of these 7 cases was patient management clinically altered as a result of the positive screen. The total additional cost for the HPLC component was $16,205 ($35x463), an average distributive charge of $2,315 per patient in whom the HPLC portion provided additional clinical information ($16,205/7). Although adding significant charges to the evaluation of suspected toxic exposures in children, the HPLC component of the comprehensive drug screen was of no additional clinical benefit compared with its limited component alone.

Adolescent↗

PubMed2003

Listening comprehension and working memory are impaired in attention-deficit hyperactivity disorder irrespective of language impairment.

This study investigated listening comprehension and working memory abilities in children with attention-deficit hyperactivity disorder (ADHD), presenting with and without language impairments (LI). A 4-group design classified a community sample (n = 77) of boys aged 9-12 into ADHD, ADHD + LI, LI, and Normal groups. Children completed tests of basic language and cognitive skills, verbal and spatial working memory, and passage-level listening comprehension. Multivariate analyses and post hoc comparisons indicated that ADHD children who did not have co-occurring LI comprehended factual information from spoken passages as well as normal children, but were poorer at comprehending inferences and monitoring comprehension of instructions. ADHD children did not differ from normal children in verbal span, but showed significantly poorer verbal working memory, spatial span, and spatial working memory. The ADHD + LI and LI groups were most impaired in listening comprehension and working memory performance, but did not differ from each other. Listening comprehension skills were significantly correlated with both verbal and spatial working memory, and parent-teacher ratings of inattention and hyperactivity/impulsivity. Findings that children with ADHD but no LI showed subtle higher-level listening comprehension deficits have implications for both current diagnostic practices and conceptualizations of ADHD.

Attention Deficit Disorder with Hyperactivity↗

PubMed1997

Sentence comprehension in Alzheimer's disease: effects of grammatical complexity, speech rate, and repetition.

Caregivers of patients diagnosed with Alzheimer's disease (AD) are often advised to modify their speech to facilitate the patients' sentence comprehension. Three common recommendations are to (a) speak in simple sentences, (b) speak slowly, and (c) repeat one's utterance, using the same words. These three speech modifications were experimentally manipulated in order to investigate their individual and combined effects on sentence comprehension in AD. Fifteen patients with mild to moderate AD and 20 healthy older persons were tested on a sentence comprehension task with sentences varying in terms of (a) degree of grammatical complexity, (b) rate of presentation (normal vs. slow), and (c) form of repetition (verbatim vs. paraphrase). The results indicated a significant decline in sentence comprehension for the AD group. Sentence comprehension improved, however, after the sentence was repeated in either verbatim or parapharsed form. However, the patients' comprehension did not improve for sentences presented at the slow speech rate. This pattern of results is explained via-à-vis the patients' working memory loss. The findings challenge the appropriateness of several clinical recommendations.

Aged↗

PubMed2005

Sentence comprehension in adolescents with Down syndrome and typically developing children: role of sentence voice, visual context, and auditory-verbal short-term memory.

The authors evaluated the roles of auditory-verbal short-term memory, visual short-term memory, and group membership in predicting language comprehension, as measured by an experimental sentence comprehension task (SCT) and the Test for Auditory Comprehension of Language--Third Edition (TACL-3; E. Carrow-Woolfolk, 1999) in 38 participants: 19 with Down syndrome (DS), age 12 to 21 years, and 19 typically developing (TD) children, age 3 to 5 years, matched on syntax comprehension, as measured by TACL-3 Subtests II and III. Of the 5 dependent measures of comprehension, auditory-verbal short-term memory accounted for significant amounts of variance in 4; group membership, 1 (semantic role assignment); and visual short-term memory, 0. In the group with DS, hearing status predicted variation in Grammatical Morphemes (TACL-3 Subtest II). Using the SCT, the authors also investigated the effects of varying sentence voice and supporting visual context on sentence comprehension. SCT performance was significantly poorer in terms of (a) referent selection and semantic role assignment, for passive (vs. active) sentences in both groups, and (b) semantic role assignment in all sentences for the group with DS (vs. the TD group). Vocabulary strengths in the group with DS were found with the Peabody Picture Vocabulary Test--Third Edition (L. M. Dunn & L. M. Dunn, 1997) but not the TACL-3 Vocabulary subtest.

Adolescent↗

PubMed1978

I don't understand what you mean by comprehension.

Current clinical approaches to the assessment of language comprehension in children are characterized by the measurement of "receptive" knowledge of lexical items and syntactic structure. A more comprehensive approach would go beyond measuring the child's ability to comprehend the literal meaning of sentences to include two other aspects of obtaining information from spoken utterances: presupposition and inference and illocutionary acts. A selected review of clinical instruments measuring language comprehension that are in current use is presented, revealing that these tests of vocabulary, basic concepts, and comprehension of syntactic structure are limited to the literal-meaning aspect of spoken messages. Tests of intelligence and reading skills for children and tests for adult aphasia include more complex comprehension items that require linguistic integration and inference. There are no tests that measure the listener's ability to determine the speaker's illocutionary intent. An integrated approach to the measurement of language comprehension is not available in the form of clinical tests.

Humans↗

PubMed1990

Aphasic subjects' comprehension of synthetic and natural speech.

This study investigated the ability of aphasic patients with mild auditory comprehension problems to respond to synthetic speech produced by an inexpensive speech synthesizer attached to a personal computer. Subjects were given four practice sessions with synthetic speech; testing of synthetic speech comprehension was performed during Sessions 1 and 4. During testing, aphasic subjects' comprehension of synthetic speech was compared with their comprehension of natural speech on four tasks: (a) picture identification, (b) following commands, (c) yes/no questions, and (d) paragraph comprehension with yes/no questions. Aphasic subjects comprehended natural speech better than synthetic speech in Session 1 but not in Session 4. Their synthetic speech scores improved between Sessions 1 and 4. There was also a significant difference among scores on the four tasks for both sessions. The means for picture identification were highest, followed by yes/no questions, commands, and finally paragraph comprehension for both sessions. Although performance by some subjects on some tasks was accurate enough to indicate that an inexpensive speech synthesizer could be a useful tool for working with mild aphasic patients, considerable caution in selecting both tasks and patients is warranted.

Adult↗

PubMed1990

Comprehension monitoring in language-disordered children: a preliminary investigation of cognitive and linguistic factors.

This study provided a preliminary investigation of the relative influence of cognitive and communicative factors in comprehension monitoring. This question was approached by studying language-disordered (LD) children for whom these abilities are presumably dissociated. Their performance on an ambiguity detection task was compared to that of two groups of control children, one matched for comprehension level and the other for cognitive level. Results revealed that LD children performed similarly to the control children who were matched for level of comprehension. The LD children's performance was examined along a continuum of the relative influence of cognitive and communicative factors, given that neither type of factor alone could sufficiently account for effective comprehension monitoring. It was concluded that communicative factors, both active primary comprehension and social communicative knowledge, had a stronger influence than the cognitive factors in our particular comprehension monitoring task.

Child↗

PubMed1989

The effects of emphasis on passage comprehension.

It may be inferred from reaction time studies that the location of emphasis on nouns and noun phrases facilitates their comprehension (understanding and memory). However, we know of no previous demonstration of improved passage comprehension in normal listeners associated with emphasis placement. The present experiment examined effects of emphasis on comprehension of 12 passages that were read aloud and tape recorded. Emphasis placement was varied by splicing sentences containing emphasized or nonemphasized noun phrases into passages without altering the wording of the passages. These passages, contrasting in emphasis, were presented to 60 listeners. Comprehension was measured with multiple-choice, recognition questions that required subjects to link ideas across sentences. Comprehension was accurate significantly more often when correct response alternatives had been emphasized (71%), than when incorrect alternatives had been emphasized (56%), or no emphasis occurred in passages (57%). Findings reflect enhanced comprehension of emphasized items in terms of their meaning links to other concepts presented in passages. Results support the pragmatic assumption that the role of emphasis is to delineate constituents important in discourse meaning.

Communication↗

PubMed2000

"Putting things in context": literal and discourse approaches to comprehension assessment.

Research on receptive language development in typical children, especially as explicated in a classic paper by Robin Chapman, is reviewed. These findings raise three challenges for clinicians assessing comprehension in children with language disorders: (1) contrary to popular wisdom, comprehension does not always precede production in a simple step-by-step way; (2) comprehension is a private event; indicators of comprehension must be used to assess it, and these indicators can be misleading; and (3) children with subtle comprehension deficits may do well on standardized tests that are not sensitive to their difficulties with real-time discourse. Some strategies for addressing these challenges, as well as a framework for assessing comprehension, are offered.

Child Language↗

PubMed2001

Speech comprehension is correlated with temporal response patterns recorded from auditory cortex.

Speech comprehension depends on the integrity of both the spectral content and temporal envelope of the speech signal. Although neural processing underlying spectral analysis has been intensively studied, less is known about the processing of temporal information. Most of speech information conveyed by the temporal envelope is confined to frequencies below 16 Hz, frequencies that roughly match spontaneous and evoked modulation rates of primary auditory cortex neurons. To test the importance of cortical modulation rates for speech processing, we manipulated the frequency of the temporal envelope of speech sentences and tested the effect on both speech comprehension and cortical activity. Magnetoencephalographic signals from the auditory cortices of human subjects were recorded while they were performing a speech comprehension task. The test sentences used in this task were compressed in time. Speech comprehension was degraded when sentence stimuli were presented in more rapid (more compressed) forms. We found that the average comprehension level, at each compression, correlated with (i) the similarity between the frequencies of the temporal envelopes of the stimulus and the subject's cortical activity ("stimulus-cortex frequency-matching") and (ii) the phase-locking (PL) between the two temporal envelopes ("stimulus-cortex PL"). Of these two correlates, PL was significantly more indicative for single-trial success. Our results suggest that the match between the speech rate and the a priori modulation capacities of the auditory cortex is a prerequisite for comprehension. However, this is not sufficient: stimulus-cortex PL should be achieved during actual sentence presentation.

Auditory Cortex↗

PubMed1996

Effects of advance questions on reading comprehension.

Based on research on working memory and on advance organizers, the author hypothesized that advance information could have a negative effect on reading comprehension. College students read two expository passages and then responded to multiple-choice comprehension questions. In Experiment 1, advance information in the form of stems of multiple-choice comprehension questions was provided to participants in one condition, whereas participants in a control condition received no advance information. Participants who had received information about comprehension questions in advance of reading the text did not perform better in answering comprehension questions that those who did not receive advance information. In Experiment 2, readers were allowed to refer back to the text after encountering the comprehension questions. Those who received advance information on the questions made more errors than participants who did not receive advance information.

Adult↗

PubMed1999

The functional neuroanatomy of comprehension and memory: the importance of prior knowledge.

Stories are a common way in which humans convey and acquire new information. Their effectiveness and memorability require that they be understood which, in turn, depends on two factors-whether the story makes sense and the prior knowledge that the listener brings to bear. Comprehension requires the linking of related pieces of information, some provided within the story and some by the listener, in a process establishing coherence. In this study, we examined brain activations associated with story processing. During PET scanning, passages of prose were read twice to subjects during successive scans with the requirement to remember them. These were either standard stories that were readily comprehensible, or unusual stories for which the global theme was very difficult to extract without prior knowledge of the mental framework. This was manipulated by the provision of relevant, irrelevant or no visual cues shortly before the story. Ratings of comprehension provided by the subjects just after each scan confirmed that standard stories were more comprehensible than the unusual stories, as were unusual stories with a mental framework compared with those without. PET results showed activation of anterior and ventral parts of the medial parietal/posterior cingulate cortex in association with hearing unusual stories when subjects were given prior knowledge of what it might be about. Medial ventral orbitofrontal cortex and left temporal pole activations were found to be associated with more general aspects of comprehension. Medial parietal cortex (precuneus) and left prefrontal cortex were associated with story repetition. We suggest that while the temporal pole is involved in the linking of propositions to build a narrative, the anterior medial parietal/posterior cingulate cortex is concerned with linking this information with prior knowledge. All of this occurs in the context of a general memory processing/retrieval system that includes the posterior parietal (precuneus) and prefrontal cortex. Knowledge of how distinct brain regions contribute differentially to aspects of comprehension and memory has implications for understanding how these processes break down in conditions of brain injury or disease.

Acoustic Stimulation↗

PubMed1998

Icons improve older and younger adults' comprehension of medication information.

We examined whether timeline icons improved older and younger adults' comprehension of medication information. In Experiment 1, comprehension of instructions with the icon (icon/text format) and without the icon (text-only format) was assessed by questions about information that was (a) implicit in the text but depicted explicitly by the icon (total dose in a 24 hour period), (b) stated and depicted in the icon/text condition (medication dose and times), and (c) stated but not depicted by the icon (e.g., side effects). In a separate task, participants also recalled medication instructions (with or without the icon) after a study period. We found that questions about dose and time information were answered more quickly and accurately when the icon was present in the instructions. Notably, icon benefits were greater for information that was implicit rather than stated in the text. This finding suggests that icons can improve older and younger adults' comprehension by reducing the need to draw some inferences. The icon also reduced effective study time (study time per item recalled). In Experiment 2, icon benefits did not occur for a less integrated version of the timeline icon that, like the text, required participants to integrate dose and time information in order to identify the total daily dose. The integrated version of the icon again improved comprehension, as in Experiment 1, as well as drawing inferences from memory. These findings show that integrated timeline icons improved comprehension primarily by aiding the integration of dose and time information. These findings are discussed in terms of a situation model approach to comprehension.

Adult↗

PubMedDate not supplied

Comprehension of written health care information in an affluent geriatric retirement community: use of the Test of Functional Health Literacy.

BACKGROUND: The comprehension of written health care information, e.g. prescription bottle labels or an informed consent form, impacts on communication with patients and their ability to understand medical procedures, as well as goals of therapy. OBJECTIVE: To determine if the problem of literacy was present in a population of affluent Albuquerque retirement community dwellers. METHODS: We administered the Test of Functional Health Literacy in Adults (TOFHL) to 93 residents (71 women and 22 men), using a one-on-one directed examination conducted by one of the authors (J.G.B.). RESULTS: The group studied had a mean age of >70 years, were not acutely ill, had no known loss of mental function, were better educated and had a high standard of living compared to national standards. However, 30% (95% confidence level) of our group were unable to adequately comprehend written information as measured by the TOFHL. The subgroup with poor comprehension (21 women and 7 men) had a mean age of 85 years (versus 82 years in the group with good comprehension) and a mean of 13 years (versus 15 years in the group with good comprehension) of formal education. Multivariate analysis was consistent with a negative effect of age (p = 0.04), a positive effect of years of formal education (p = 0.0005) and no effect of gender on the TOFHL score. CONCLUSION: Two recent studies, one in an emergency room setting and the other among Medicare enrollees, demonstrated similar results to ours. The high prevalence of poor comprehension in these groups should alert providers to the need to develop additional or different communication skills that can address the problem of poor reading comprehension across at least three diverse groups of people, with particular attention to those over the age of 65.

Aged↗