Speech-Language Pathology and clinical linguistics--hope beyond the horizon!

ABSTRACT

The discipline of Speech-Language Pathology is a specialized field that most often adopts some of the principles from various other disciplines including Linguistics. Since long, the strength of Linguistics and its application to clinical population was evident through the work of Aphasiologists. Yet, to date, the two disciplines have remained wide apart. The paper attempts to discuss the role of clinical linguistics drawing a few samples of clinical linguistic analysis from the author's research work. The paper also discusses the reasons for the two disciplines to stay apart for so long. Future directions are given to bridge the gaps in the knowledge source so that both the fields mutually benefit and that the clinical practice in Speech-Language Pathology becomes more efficient and effective.

The discipline of Speech-Language Pathology since its emergence has been addressing the issues related to language acquisition and its disorders--both in children and adults, while the linguistic science focuses towards the establishment of "standard language", second language teaching/learning and the nuances of cultural-linguistic diversity. Given the tangential interests of the two disciplines, mutual application of principles of one to the other (Linguistics to Speech-Language Pathology and vice versa) although is very crucial, is still in its infancy.

Historically, the contribution of Roman Jakobson's theory of phonemic disintegration (1956) to Aphasia could be considered as the beginning of the convergence of the two disciplines. His valuable contribution to draw Aphasiology away from the mere surface description of symptoms and to provide the first interpretations of aphasics' language disturbances in a linguistically motivated way is a significant milestone in the history of Linguistics. The seeds of application of linguistic principles to clinical needs were thus sown which gradually led to a spate of studies (Crystal 1972). Consequently, the pioneering work of David Crystal and his influence led to the emergence of "Clinical Linguistics" as a coherent sub-discipline of Applied Linguistics during 70's and 80's in the UK (Perkins and Howard 1995).

Clinical Linguistics broadly leads to an understanding of application of theoretical and descriptive linguistics to Speech-Language Pathology. Crystal defines it as the application of theories, methods and findings of Linguistics (including Phonetics (1)) to the study of "those situations where language handicaps are diagnosed and treated" (Ball 1988). In other words, clinical linguistics is seen primarily as an applied discipline, to clinical practice in which the analysis of language disability from a linguistic perspective often raises issues of a theoretical nature.

Although theorists (2) and practitioners may be interested in the same phenomena, aims are quite different. Theorists are interested in clinical linguistic behavior to the extent that it may confirm or disconfirm their hypothesis about the nature of language. Speech-Language Pathologists on the other hand are interested in linguistic theory to the extent that it may be of some clinical use. Considering the interests of both, the time is ripe to shift the emphasis in the relationship between Clinical Linguistics and Speech-Language Pathology from the application of "clinical language data to linguistic ends" to the application of "linguistics to clinical ends" (Crystal 1981). There is also a need to move away from "standard language" to "language standards" keeping in the interest of both the disciplines. A brainstorming exercise regarding the current status of Language Sciences and Speech-Language Pathology is needed at this crucial hour in order to find a solution to the question: "Are we in India equipped with the necessary skills to blend the principles of both the disciplines for a better understanding?"

LANGUAGE SCIENCES AND SPEECH-LANGUAGE PATHOLOGY: CURRENT STATUS IN INDIA

The term Language Sciences implies on the one hand that it could be a scientific study of language structure, components, principles, properties, and cross-linguistic issues in the acquisition, teaching, second language learning as well as language loss and or deterioration. From the literary point of view, one could also consider the diversified nature of its usage in various dialects, poetry language, historical development, colloquial, official and machine language.

The various domains of language sciences have long been in the interest of linguists, sociologists and litterateurs. Therefore, there exists abundant literature in India on the issues related to these disciplines. But, the most needed database on Indian languages and scripts with reference to the clinical population that is of interest to Speech-Language Pathology exists only in countable universities and departments. Therefore indigenous database and information is not available for functional usage and mutual application. The reason for this could be the nature and type of training programs in Linguistic Sciences and Speech-Language Pathology that exists in the Indian context thus leading to this extreme division of interests of the two disciplines.

The training programs in Language Sciences are available in very few universities and selected departments. The number of personnel trained at the post-graduate level in this discipline is around 60 / year (Ref: websites of Indian Universities and personal communication with faculty of premier training institutions). Consequently, the manpower required to investigate the special status of our country with multilingualism, multiculture and multiliteracy has been significantly low. A review of the curriculum for language sciences also suggests that it is devoid of many specialized areas of application particularly its application to clinical population. However, there is an effort in the recent past (around 1999) to formulate a course curriculum for Diploma in Clinical Linguistics with the inclusion of clinical phonetics, clinical linguistics, neurolinguistics and psycholinguistics. This is viewed as a beginning and a stepping stone for the "movement" towards the convergence of the two disciplines.

The curriculum for the training programs in Speech-Language Pathology on the other hand is focused more towards the components of language, language acquisition and the application of psycholinguistic and neuroliguistic principles to Speech-Language Pathology. The Speech-Language Pathologists are involved in investigating the peripheral components of language, speech fluency, articulation, rate of speech and voice parameters. This could be because the curriculum in Speech-Language Pathology gives relatively more emphasis to the theoretical component in comparison to the practical training (3). Speech-Language Pathologists feel that they are probably "ill equipped" and therefore are "threatened" to apply the theoretical knowledge to the clinical data (personal discussion with the alumni). Due to the lack of expertise and skills, these trained professionals move towards the more confident "core areas" than the less confident "applied areas". Consequently, the hope of convergence of principles appears to be far from reach.

CLINICAL LINGUISTICS AND SPEECH-LANGUAGE PATHOLOGY: REFLECTIONS FROM AUTHOR'S WORK

The following examples drawn from author's research work illustrate the strength of clinical linguistic analysis / profiling in clinical practice of Speech-Language Pathology. The usefulness of application of Linguistics to clinical needs for the purpose of screening, differential diagnosis, localization of lesion is supported. The necessity of careful micro profiling and analysis of language samples for a better understanding of the clinical conditions is emphasized thus supporting the premise that Clinical Linguistics is an integral component of Speech-Language Pathology.

CLINICAL PHONOLOGY 

Samples 1a and 1b illustrate the phonetic errors manifested by a young child who is in the process of language development and another older child with articulatory errors that are consistent across the stimulus words. Broad phonetic transcription of language sample facilitates screening of the two conditions and directs towards further management.

1. Phonetic errors

1a) Developmental errors in articulation

/Te:n/ for /Tre:n/ 'train' /pi:z/ for /pli:z/ 'please' /[t.sup.h] i:/ for /[t.sup.h]ri:/ 'three'

/lavi/ for /ravi/ 'nominal form'

Cluster reduction and lateralization 

1b) Articulation disorder 

/tata/for /TaTa/ 'wave good bye' /ten/ for /Ten/ 'the number Ten' /tu/ for /Tu/ 'the number Two'

/b[??]t/ for /b[??]s/ 'Bus' /to:p/ for /so:p/ 'Soap' /te:l/ for /ske:l/ 'scale'

Fronting and absence of retroflex 

2. Phonemic errors

Sample 2a and 2b indicate phonemic errors manifested by an adult with transcortical sensory aphasia and a child with post encephalitic language disorder.

2a) Phonemic errors in a person with aphasia

/ni:T[??]l/ for /ni:D[??]l/ 'needle' /sikk[??]/ for /siTT[??]/ 'sitting' /b[??]l/ for /g[??]l/ 'girl' /k[??]p/ for /k[??]T/ 'cut'

2b) phonemic errors in a child with

post encephalitic language disorder /so:fo/ for /so:f[??]/ 'sofa' /tuTid[??]aLu/ for /tuTigaLu/ 'lips' /b[??]lu:/ for /blu:/ 'blue' /ba:ligu/ for /ba:gilu/ 'door'

3. Semantic errors

Samples 3a and 3b show semantic parapahasia in an adult with aphasia with lesion in sub cortical areas and in a child with post seizure language disorder.

3a) Semantic paraphasia in adult aphasia

/w:pi[??]/ for /kraI[??]/ ' crying /Dres/ for /kl[??]t / 'cloth' /laiT/ for /laemp/ 'lamp' /l[??]k/ for /ki:/ 'key' /br[??]d[??]r/ for /h[??]zb[??]nd/ 'husband'

3b) Semantic paraphasia in a child with post seizure language disorder

/spu:n/ for /nu:d[??]ls/ 'noodles' /pensil/ for /pen/ 'pen' /amma ide/ for /amma illa/ 'confusion between honorific modal verb to indicate presence Vs. absence'

4. Perseveratory errors

Comparison of language samples transcribed over a fixed duration for specified stimuli also helps to differentiate between "normal errors" and "pathological errors" as shown in sample 4 drawn from the study on normally aging healthy individuals and aphasic population.

4) Perseveratory errors

Syntactic perseveration

Person with brain damage                  Normal healthy geriatric

Therapist: Who cooks food?                /adigam vendam adigam vendam/
Client: /daughter cook food/              'more do not want'

Therpist: What did you read in paper?
Client: /Cook food. No,no ... accident/

Phonemic perseveration 

On seeing a picture of a ball, the client named it as /pa pa pandu/ ' ball'

Therapist showed a picture of a tree and asked the client to name it

Client: /three. ... no,no,th, th/ . He tries to correct himself and shows the tree outside the window and comes out with the word /tree/.

The applications of Clinical Linguistic principles are far and wide in many areas such as bi/multilingualism, pragmatics, accent & prosody, language & literacy to name a few. The above illustrations of linguistic data are only but a few that support the need for detailed transcription, micro profiling and careful analysis of a client's language sample, which would facilitate clinical practice and research goals of a Speech-Language Pathologist as well as a Clinical Linguist.

FUTURE DIRECTIONS

The interest of Speech-Language Pathologists are generally around organization and representation in the brain, the process of its production and understanding, characteristics of language disorders and goal setting in cases of language regression and developmental disorders. Since Clinical Linguistics is seen primarily as an applied discipline, its status could be well justified only when it is shown to contribute to remedial progress. Ball (1987) argues for a definition of clinical linguistics, which includes the contribution of the study of clinical data that can make to linguistic theory. Relationship between linguistic theory and description on the one hand and practical clinical concerns on the other are therefore mutually influential.

Careful and systematic description of client's communicative behavior provides a means of assessing that behavior in relation to linguistic and developmental norms. Clinical linguistic analysis reveals systematic and communicative status of the client's linguistic patterns regardless of considerations of target norms, thus facilitating to establish "language standards" instead of "standard language". Information also facilitates formulations of specific treatment aims and strategies. Careful analysis at different points during assessment and management allows identification, differential diagnosis, estimation of prognosis and evaluation of changes in client's communicative behavior over time.

The sample illustrations presented in this paper rise "hope beyond the horizon" the convergence of Linguistic Science and Speech-Language Pathology. Computational Scientists and Cognitive Psychologists also need to join hands in this mission so that Crystal's vision of "linguistics to clinical ends" could be met with confidence. Since the complexity of normal language and literacy phenomena itself is so complex, one can imagine the complexity of the disorders of language and literacy. This suggests that there is an immense need to blend the knowledge sources from different disciplines. Intensive and extensive exercise of knowledge and skill is required to develop indigenous database on "normal" and "disorders" of language. The onus on the part of a Speech-Language Pathologist such as accountability in clinical practice, clinical audit and evidence-based research and practice can be facilitated only when empirical studies are conducted by employing the principles of Clinical Linguistics. Clinical Linguistics has much to offer for outcome and efficacy measures also. The time is quite ripe for the two disciplines to plan and implement mutually beneficial curriculum and to share manpower resources, knowledge, experience and expertise to meet each other's objectives.

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REFERENCES

Ball M. J. 1988. Clinical Linguistic Encounters. Clinical Linguistics and Phonetics, 2, 143-151.

Ball, M. J. & Kent R. D. 1987. Editorial. Clinical Linguistics and Phonetics, 1, 1-5.

Chandralekha, C. & Prema, K. S. 2001. Verbal Perseveration in Geriatric Tamil Speakers. Unpublished.

Crystal, D. 1972. The case for linguistics: A prognosis. British Journal of Disorders of Communication, 7, 3-16.

Crystal, D. 1981. Clinical Linguistics. 4th ed. Vienna: Springer-Verlag.

Crystal, D. 1984. Linguistic Encounters with Language Handicap. Oxford: Blackwell

Jakobson, R. 1956. Two aspects of language and two types of aphasic disturbances. In R. Jakobson & M. Halle (Eds.), Fundamentals of Language. Mouton: The Hague.

Perkins, M. & Howard, S. (eds.) 1995. Case Studies in Clinical Linguistics. London: Whurr Publications.

NOTES

(1.) The issue of whether clinical phonetics should be regarded as a sub discipline of clinical linguistics or as a separate discipline in its own right is discussed in Ball (1988a).

(2.) In the context of the present discussion, the author considers Linguists as theorists and Speech-Language Pathologists as practitioners.

(3.) One of the reasons for this could be due to non-availability of faculty who could impart knowledge from both the disciplines since the training programs do not blend aspects of both the disciplines in totality (This is only the personal opinion of the author and not referenced).

DR. K.S. PREMA

PH.D (SPEECH & HEARING)

READER IN LANGUAGE PATHOLOGY

DEPT.OF SPEECH-LANGUGE SCIENCES

ALL INDIA INSTITUTE OF SPEECH AND HEARING 

NAIMISHAM CAMPUS,

MANASAGANGOTHRI MYSORE 570 006

TEL: [phone] (252)

E MAIL: <[e-mail]>