adynamic aphasia , inner speech and rehab

"The Mechanism of 'Dynamic Aphasia'" ( 1968) was co-authored with L. S. Tsvetkova, and postulates that dynamic aphasia is a disturbance of "inner speech with its predicative function, which takes place in forming the structure or scheme of a sentence, . . ." ( Luria & Tsvetkova, 1968, p. 297). The article reports on their attempts to test this by experiments with 15 patients with dynamic aphasia and 15 normal subjects. The aphasia patients exhibited more difficulty in naming actions than in naming objects, and could not form sentences out of all the separate words necessary to do so. Normal patients had no difficulty with either task. External cues (such as pieces of paper) assisted the subjects in compensating for this loss of the "linear scheme of the phrase . . ." ( Luria & Tsvetkova, 1968, p.
"Frontal Lobe Syndromes" ( Luria, 1969a) constitutes a chapter in the Handbook of Clinical Neurology, Vol. 2, edited by P. J. Vinken and G. W. Bruyn , and provides a comprehensive consideration of the morphology and functioning of the frontal lobes.
Luria provides such basic information as the fact that the frontal lobes are the youngest portion of the cerebral hemispheres evolutionarily; comprise approximately one third of the total human cerebral cortex; and consist of three main regions: the motor area, the premotor area, and the prefrontal area together with the mediobasal aspects of the frontal region. The complexity of this area of the brain is evidenced by the fact that Layer III of the neocortex in Area 6 of the premotor area contains approximately 207 million pyramidal cells. Because each cell may have 2-3,000 synapses, the reader can gain some appreciation of the multiplicity of connections with other areas of the brain of which the frontal lobes are capable.
The most complex zones of the frontal lobes do not complete their physical development until the individual is 7-12 years of age; and the integrative tertiary zones of cortical development are found in the prefrontal region.
A detailed analysis is presented of the morphological, physiological, and clinical data on each of the three regions of the frontal lobes. Of particular interest are the disturbances of higher mental processes and speech that result from lesions in these regions. These have been presented in the reviews of other articles on the frontal lobe syndrome, but this chapter presents the same in more detail and states:
Analysis of these disturbances shows that they are based on difficulty in performing complex movements generalized in time. There is difficulty in denervating one link and moving on smoothly to the next. This disturbance of "kinetic melodies" is the fundamental symptom of a premotor lesion . . . . ( Luria, 1969a, p. 731)
With respect to how frontal lobe lesions affect speech, Luria states that
If the lesion is situated in the inferior portions of the premotor area of the dominant (left) hemisphere, phenomena similar to the disturbances of kinetic melodies described above may also appear in speech and verbal thinking. The patients of this group begin to have difficulty in fluent speech, their speech becomes interrupted, and difficulties arise in the transition from one element of articulation to another. Similar phenomena of the loss of smoothness (and sometimes of perseveration) may also appear in writing. ( Luria, 1969a, p. 733)
If the symptoms are severe, one has a case of efferent (or kinetic) motor aphasia.
The symptoms of frontal lobe lesions vary somewhat, of course, depending upon the location of the lesion; however, Luria indicates that there are two main symptoms that occur
in almost every massive lesion of the prefrontal regions. The first of these symptoms was a disturbance of the complex forms of active purposive behavior, and the second a disturbance of the critical attitude towards the patient's own defects. Both of these components of the "frontal syndrome" were observed as a rule in all massive lesions of the frontal lobes, although they varied in lesions of the convex and basal portions of the frontal region, and differed depending on the severity of the lesion . . . . ( Luria, 1969a, p. 738)
When such characteristics arise from a lesion of the left prefrontal region, they are manifested in speech activity and verbal thinking and distinguish the aphasia Luria labels dynamic aphasia.
"