Contents

1 Background Information :.......................................................................................................2

1.1 Medical Diagnosis...........................................................................................................2
1.2 Speech & Language Therapy Diagnosis.........................................................................2
1.3 Strength:...........................................................................................................................2
1.4 Weakness:........................................................................................................................2
2 Task 01 Palpa Model...............................................................................................................3
3 Task 2- Hypothesis..................................................................................................................4
3.1 Hypothesis-1 :..................................................................................................................4
3.2 Hypothesis- 2:..................................................................................................................4
3.3 Hypothesis-3:...................................................................................................................4
4 Task 3- Further investigate......................................................................................................5
4.1 Repetition: Syllable length..............................................................................................5
4.2 Familiar person naming:..................................................................................................5
5 Task 4 - Activity limitation & Participation restriction..........................................................5
5.1 Activity limitation............................................................................................................5
5.2 Participation restriction....................................................................................................5
6 Reference................................................................................................................................6
1 Background Information :

Name: Mr. Abul Kalam

Age: 74
Occupation: Retired Professor of Bangla Language
1.1 Medical Diagnosis
Md. Abul Kalam has hypo-perfusion of the left frontal cortex and of the right cerebellum.
He has stenosis of 90% of the internal carotid artery and for this reason he has to undergo
an endarterectomy.
He has infraction of the area of the middle cerebellum artery extended to the nucleus
lentiformis.
He has severe depression and signs of frustration with his situation.
1.2 Speech & Language Therapy Diagnosis
 Md. Abul kalam has severe global aphasia (both in comprehension and expressive).
 His auditory comprehension is severely disturbed.
 He is not able to perform with the task of single commands.
 He is better on visual association tasks at word level.
 His writing is very good, he can write words and short sentences in capital letters
without phonological paragraphias.
 His spontaneous language is characterized by unintelligible speech.
 His comprehension is good on words level as well as good on sentence level.

1.3 Strength:

• He achieved better on visual association tasks at word level (written word - object /
picture).
• His writing was very good (80%) compared to 3 weeks post onset (13%).
• His comprehension was good on word level and relatively good on sentence level.

1.4 Weakness:

• Md. Abul Kalam had severe global aphasia (both comprehension and expressive) with
mutism.
• His auditory comprehension was severely disturbed.
• His spontaneous language was characterized by unintelligible speech
 2 Task 01 Palpa Model

According to Cognitive Neuropsychology Model (PALPA model) Md. Kalam’s language

processing difficulties are shown below-

[Note: The boxes which have problem are marked by Red Colour ( ) ]

Print
Speech Picture/Seen object
Abstract Letter
Auditory
Identificition
Phonological
Analysis

Orthographic
Phonological Input Lexicon
Output
Buffer

Phonological Visual Object Letter to sound

Input Recognition Ruler
Lexicon System

Acoustic
Phonological Symantic
Conversion System

Orthographic
Phonological Output Lexicon
Output
Lexicon

Phonological Sound to Orthographic

Output Buffer Letter Rules Output Buffer

Speech Print
3 Task 2- Hypothesis

Hypothesis on Md. Kamal’s communication difficulties-

3.1 Hypothesis-1 :
Md. Kamal has an impairment in his Acoustic to phonological conversion.
• Rational:
“As the Acoustic to phonological conversion bypasses the lexicons, it allows repetitions
of non- words” (Whitworth, 2005).
From the above quotation, we can learn that, to repeat a non- word, a person needs to use
his
Acoustic to phonological conversion, because he cannot repeat a non-word through the
lexical route (phonological input buffer- phonological input lexicon- semantic system-
phonological output lexicon) as the word is not stored in his phonological input lexicon. As
he cannot access the lexicon, the person cannot access to the semantic system. So, he needs
to bypass the lexicons, to repeat the non-word.
From the repetition section of Md. Kamal’s Comprehensive aphasia test (CAT), it is assed
that he can repeat only one (1) non-word, out of five (5). On the other hand, he can repeat
single real words better (11/16) then non-words, which are a clear indication of lesion in
Acoustic to phonological conversion (APC) box in PALPA model.
3.2 Hypothesis- 2:
Md. Abul Kalam has impairment in his Phonological Output Lexicon.
• Rational:
“An impairment at this level results in impaired word retrieval in spoken naming but
written word retrieval may be intact” (Whitworth, 2005).
Here the person knows the meaning of the word but cannot access its phonology. To access
the meaning of a word phonologically, a person needs to use Phonological Output Lexicon
route.
So here the lesion in Phonology Output Lexicon.
3.3 Hypothesis-3:
Md. Kamal has an impairment in his Phonological Input Lexicon.
 Rational:
“Phonological input lexicon to phonological output lexicon route allows repetition of
non - words and also contributes in real word repetition. Impairment of this box will
have a profound effect on auditory comprehension " (Whitworth, 2005).
Here this person scores only 58 out of 120 in single word repetition. In means he can't
repeat words properly. And his auditory comprehension is severely damaged. So, it is
ensured that he has problem in phonological input lexicon. In case of Mr. Kamal, he can
 read aloud single words and complex words pretty good. This indicates that he has no
problems in abstract letter identification and orthographic input lexicon

4 Task 3- Further investigate

To find out Md. Abul Kalam’s impairment in language process accurately, further
assessment is needed. These are-
 Hearing test
 Spoken naming: response to phonemic cuing test
 Repetition: Syllable length
 Familiar person naming
To further investigate the above three hypotheses, two formal test could be carried out.
These are-
4.1 Repetition: Syllable length
To ensure the lesion of Phonological Output Buffer, repetition of syllable length can be
assessed. Here Md. Abul Kalam has poor repetition in single word. Length effects in all
tasks requiring spoken output (Whitworth, 2005. If Md. Abul Kalam cannot response in
repetition of syllable length than it can be ensured that he has problems in Phonological
Output Buffer.
4.2 Familiar person naming:
To ensure the lesion in OOB, familiar person naming can be assessed. As Mr. Kamal’s own
name is the most frequently used used word in his life, he somehow can access to the OOB.
But as the family members name is less frequently used, testing the ability to write familiar
peoples name can actually test orthographic output buffer. If he cannot assemble the
spelling of the names, the existence of the lesion in OOB can be proved.

5 Task 4 - Activity limitation & Participation restriction

5.1 Activity limitation

 In conversation he gets confused when there is a lot of back ground noise.
 Difficulty in talking in telephone
 Difficulty in reading the articles of newspaper
 Difficulty in counting money and relies on others
 Difficulty to sign his signature
 He can’t write
 He can understand only one to one conversation
5.2 Participation restriction
 Inability to participate in any meeting and social activity.
 Inability to communicate with familiar person and other persons through the telephone
 Inability to read whole news in newspaper. For this reason he can not know about his
country and world’s situation.
 Inability to buy anything from shop.
  Inability to withdraw money from the bank and can’t sign in important papers where
his sign is needed.
 Inability to participate in his job for this reason He cannot go his job
 He cannot talk with many peoples.

6 Reference

Whitworth, A. (2005). A Cognitive Neuropsychological Approach to Assessment and

Intervention in Aphasia. Psychology Press, Taylor & Francis Group. New York.