Agrammatism and Other Aphasia-related Disorders in Moroccan Arabic Speaking Aphasics

This paper includes the participation of six Moroccan Arabic-speaking aphasics (four with Broca’s aphasia, one with Wernicke’s aphasia and one with global aphasia). In our work, we turn to a particular under-resourced Arabic Dialect, Moroccan Darija or Moroccan Arabic (MA), which is an agglutinative language; that is, a fairly large number of affixes may be added to the root. Negation, tense, aspect, person, number and gender are all expressed by affixes attached to the verb. The speech corpora were taken from samples collected from patients who have attended speech and language therapy sessions. The patients were presented with picture description, repetition and grammaticality judgement tasks in order to examine the extent of impairment on the phonological, lexical, semantic and morpho-syntactic levels. Although agrammatic production is usually described as impaired in all aspects of grammar and in all types of inflection, it was found out that the use of verbal and nominal bound morphemes was spared in the output of the subjects understudy. All the three groups in this study used appropriate verbal and nominal morphology, which does not support the traditional view of agrammatism as being amorphological.


Introduction
Aphasia is a language disorder which results from brain injuries caused by strokes, tumours, metabolic disorder, toxicity, or other aetiology.This involves damage to tissue in parts of the brain on which language seems to be dependent (Lesser &Milroy, 1993: 8).Aphasia syndromes affect language areas in the brain and consequently influence the linguistic knowledge of the person affected so that his/her linguistic performance is disturbed.This disorder may result in what is known as agrammatism, an impairment involving morphosyntax and manifested by the production of ungrammatical utterances with omission or incorrect use of grammatical morphemes (Caramazza & Berndt, 1985: 33).
It was believed, until recently, that all functional elements were impaired in agrammatism ( ouhalla, 1993) and were substituted by non-linguistic strategies (Berndt & Caramazza, 1980;Caplan, 1985;Goodglass, 1976;Ouhalla, 1993;Kean, 1977;Grodzinsky, 1984), but most of the studies reported in the literature on agrammatism have been conducted on subjects from morphologically-poor languages.However, empirical evidence has suggested, in recent years, that some syntactic elements were found to be spared, and some were not equally impaired in different languages following the same lesion.For example, case and use of coordinating conjunctions were found to remain intact in Finnish and Polish agrammatic speakers (Menn and Obler, 1990), and negation was shown to be preserved in Japanese agrammatic speakers (Hagiwara, 1995), and verb inflections were also spared in Italian (De Blesser and Luzzati, 1994).
Cross-linguistic studies have shown that free grammatical morphemes are more likely to be omitted than bound morphemes in the speech of aphasic subjects speaking an agglutinative language, such as Turkish, Hungarian or Finnish (MacWhinney and Osman-Sagi, 1991;Niemi & Laine, 1989;Niemi, Laine, Hanninen et al., 1990;Slobin, 1991).Thus, free grammatical morphemes are more susceptible to omission than are bound morphemes in agglutinating languages.In this regard, Moroccan Arabic may serve as an excellent testing ground, for it is an agglutinative language with a complex verbal and nominal inflectional morphology.Apart from prepositions which were often omitted, verbal and nominal inflectional morphemes were found to be intact in the speech of the Moroccan aphasics understudy, which clearly supports the above findings on agglutinative languages.
A number of studies have shown, recently, that tense marking is particularly impaired in agrammatic speech in some languages,such as for example, English (Arabatzi & Edwards, 2002;Dickey, Milman & Thompson, 2005;Faroqi-Sha & Thompson, 2007), Arabic (Diouny, 2007), Hebrew (Friedmann & Grodzinsky, 1997), German (Buchert, Swodoba-Moll & DeBleser al., 2005a), Spanish (Benedett & Christiansen & Goodglass, 1998), Dutch (Bastiaanse, 2008).In Flourishing Creativity & Literacy (Diouny, 1990), tense and agreement disassociation was investigated in Moroccan Arabic agrammatic speakers following the TPH (Tree Pruning Hypothesis) as proposed by Pollock (1989), and it was found out that tense, but not agreement, was impaired in these patients.However, in the data understudy, tense as well as agreement marking was found to be intact, whereas prepositions were omitted most of the time.Friedmann (2001) explained the varied patterns of production observed in agrammatism in terms of the hierarchical structure of syntactic trees.While studying the syntactic structures of Hebrew and Palestinian Arabic, she noticed a hierarchical pattern of impairment in which complementizers were more impaired than verb tense inflections, and verb tense inflections were more impaired than verb agreement inflections (Friedmann, 1998(Friedmann, , 2001(Friedmann, , 2002)).Friedmann formulated the TPH (Tree Pruning Hypothesis) to account for this agrammatical variation.The idea was that if agrammatic speakers could no longer inflect verbs correctly for tense but had no problems inflecting them for subject agreement, this is mainly due to the inaccessibility of high nodes of the syntactic tree (Friedmann, 2006).This does not seem to be the case for Moroccan Arabic speaking agrammatic subjects, for both inflection for tense and subject agreement was observed to be retained in the corpora understudy.
Thus, as the studies carried out by Grodzinsky (1984Grodzinsky ( , 1990) ) and Menn & Obler (1990) have shown, agrammatism can take different forms depending on the language explored, and this is due to the fact that grammatical morphemes behave differently in different languages (Benedet, Christiansen and Goodglass, 1998).
This paper aims to examine the speech of some Moroccan-Arabic speaking aphasics in order to check areas of similarities and differences in what concerns types of impairments involved.We, therefore, contribute a corpus of Moroccan Arabic, which is an agglutinative language where verbs are inflected for tense, aspect, and the person, number and gender of the subject and object using prefixes and suffixes.This variety of Arabic, like Modern Standard Arabic (MSA), has free word order; it allows for six permutations of word order, though the most used orders are SVO and VSO.But unlike MSA, nouns in MA are not marked for case and the dual has disappeared in this variety in both nouns and verbs.Verbs have a past (or perfective) suffixed conjugation, or a non-past (or imperfective) prefixed conjugation.

Data Analysis
Our corpus is taken from samples collected during speech therapy and rehabilitation sessions.The patients, from different social backgrounds and different ages and genders, were diagnosed with different syndromes, namely Broca's aphasia (Maghnia, Ahmed, Rachida and Saddiki) and Wernicke's aphasia (Fatna) and total aphasia (Karim).

First patient:
Maghnia (M) is 40 years old, unmarried.Before her illness she was working as a nurse, but she was suffering from Mitral insufficiency which means that her blood was not flowing normally.Doctors prescribed her antibiotics for two weeks to secure her from any disease and to allow normal blood flow.Three months later, she was subject to a nervous breakdown subsequent to overwork.When she woke up one morning, she could not move her body.This was followed by a severe right-side hemiplegia and she was unable to speak.Then she was admitted at the hospital and her state improved, but her speech was still affected.Since blood flow could not reach certain parts in the left hemisphere she developed Broca's aphasia.

Second patient:
Karim (K) is a 38 year-old ex-soldier.On june 15th 1997, he was run over by a car.He underwent neurosurgery and remained unconscious for one month.As a consequence of this accident, he was suffering from a right hemiplegia, but he succeeded in moving his right hand and foot four months later.Unfortunately, he was object to a hemorrhage in the left hemisphere of the brain which resulted in total aphasia.Subsequent to this, his memory became so weak that he could not remember the names of his wife and daughter.On the linguistic level, he began to jargonify, that is, utter severely disordered and meaningless speech, and then his speech became limited to few stereotyped and limited utterances.After five months, he succeeded in indulging himself in conversations, but he still has some difficulties in some phonemes articulation.

Third patient:
Saddiki (S) is sixty-one years old.Before retiring, he was an agricultural manager.He had a problem with his unstable blood pressure.One day, he woke up with a right hemiplegia accompanied with severe aphasia.He attended many sessions of kinetic therapy and speech rehabilitation because his speech was reduced to stereotyped words and limited utterances.Also, he couldn't remember anything of what he had been or what he had done before.But after the therapy, Siddiki was able to overcome most of his linguistic problems.

Fourth patient:
Ahmed (A) is 42 years old, but seems younger.He has two children.Before his illness he was working in a textile factory.Ahmed has Broca's aphasia resulted from work accident.When he was admitted at the hospital, he was unable to speak, but now he seems to have recovered most of his linguistic skills.The only remaining handicap lies in his inability to name things.

Fifth patient:
Rachida (R) is 38 years old, unmarried.She is illiterate.She has Broca's aphasia and suffers from a right hemiplegia.It was difficult for her to express herself before therapy, but now her state has improved a great deal.

Fatna (F) is 72 years old. She is the mother of five children. She suffers from Wernicke's aphasia consequent to a cerebro-vascular accident (CVA). (F) speaks fluently, but her speech is meaningless. What is more dramatic is that she cannot remember her name as well as her children's.
The above information concerning the respective social backgrounds of these patients will help us shed light on the linguistic structures that these patients have lost and those they have retained and the abnormalities in the processing of language.So, our primary focus will bear on the components of phonology, morpho-syntax and lexicon.

Phonological disorders
The phonological paraphasias of brain-damaged patients have been the subject of numerous investigations (Alajouanine, ombredane & Durand, 1939;Jackobson, 1956;Luria, 1966Luria, , 1976Luria, , 1983;;Lecours & Lhermitte, 1969;Blumstein, 1973Blumstein, ,1981)).Nearly all aphasic patients, regardless of the clinical type of aphasia from which they are suffering, display some phonological difficulties in their speech output.This study will be restricted to consonants analysis since they are more likely to cause difficulties than vowels as they are the first segments to be affected.While a broad array of phonological disorders may occur, these can be reduced to four categories:

Substitution
Phoneme substitution is the most frequent error in aphasics' speech.It simply consists of substituting one phoneme or segment for another.For more illustration, these data from samples collected from the patients described above have been selected: Environment errors also include progressive and regressive assimilation.In the assimilation process, a segment takes on features from a neighbouring segment.A consonant may pick up features from a vowel, a vowel may take on features of a consonant, one consonant may influence another, or one vowel may have an effect on another.There are two kinds of assimilation: progressive (forward) assimilation in which the first consonant influences the second and regressive (backward) assimilation in which later consonants influence earlier ones.For further illustration, the following table shows the error mechanisms involved in the phonemic transformations found in our subjects.For every patient the most used error type was substitution while the least used was metathesis.These are some of the processes displayed in the erroneous speech of aphasic patients, but they are by no means exclusive.Moreover, the errors produced by aphasic subjects exist exclusively in the minds of hearers; in other words, it is the hearer who identifies the errors while the aphasic patients are not aware of them.

Morpho-syntactic disorders
Apart from Broca's aphasia, the term agrammatism is often used to refer to the syntactic disorder in aphasics speech.Caramazza & Berndt (1985:33) define agrammatism as "a speech ouput characterized by the omission of grammatical morphemes, reduced phrase length, the omission or nominalization of verbs, and difficulties with word order".Thus, the primary characteristic of many Broca's aphasics is productive agrammatism in which grammatical markers, such as inflections, seem to be affected, and grammatical words, such as articles, prepositions and verb modals are nearly lost; whereas content words, such as nouns, verbs, adjectives and adverbs seem to be retained in spontaneous speech and often in repetition and writing.So, if this seems to be true as far as English and typologically similar language speakers are concerned, speakers of Moroccan Arabic do not suffer from the same loss After examination of the extent of inflectional impairment, it was found out that the use of bound inflectional morphemes of tense and agreement was not impaired in their production, as the following sample, from an interview between the orthophonist and the first patient M who was asked how to prepare tea, shows : The Even if the beginning of the conversation features a semi-telegraphic style with use of content words, especially nouns and verbs and the dropping of prepositions, as in kanfarghu …alkisan above, where, normally, the preposition fi (in) should have been used , bound morphemes of person and tense are preserved, however, as in kanfarghu (prefix ka which signals the imperfective + n which stands for the first person singular pronoun + verb pour in the imperfective) and yatjammar (ya stands for the third person singular masculine pronoun + boil in the imperfective) and 'an3ammar (where 'u stands for and, and the prefix n stands for the first person singular pronoun + 3ammar (verb fill in the imperfective).
Content words are retained probably because they are 'referential'-they refer to objects, actions and attributes in the real world, and they are also the first to be acquired.First acquired first lost.Sometimes, the omission of prepositions in aphasics' speech tends to create ambiguity in the meaning of the whole sentence as the following example shows: The patient M is describing a picture showing some people eating: The patient: Yaklu attanjra

Personal pronoun+ eat definite article +pot
They are eating the pot

Instead of saying
The patient: Yaklu mn ttanjra

They eat preposition definite article+pot
They are eating from the pot So, apart from the preposition, tense and agreement affixes, as well as articles, are spared in the above conversation.
Sometimes, Broca's aphasics with agrammatism suffer from a deficit in their ability to retrieve verbs, as the following utterance demonstrates: M was asked to describe a girl who was combing her hair in front of the mirror: The patient:

Anta3 lamraya sh3arha
Of the mirror her hair The mirror her hair Though the verb is absent, the NPs lamraya (la stands for the definite article + mraya (mirror)) and sh3arha (sh3ar (hair) + ha (which stands for the possessive pronoun her) complete the missing information.Here, again, we notice that morphology was correctly used in sh3arha.
Below is an example where the NP-VP juxtaposition occurs.
The orthophonist asked the patient about her cooking skills.Her answer was: The patient:

Manaqdarch anta3
Neg+I+can+neg of I am not able of (M) wanted to say that she couldn't use her hands because of the hemiplegia she was suffering from, so, instead she used the preposition anta3 (of) to complete the sentence since she was not able to find the word hands.In general, productive agrammatism is characterized by the omission of functional words and the use of short sentences with simplified syntactic structure, the absence of subordinate clauses and the almost exclusive use of nouns and verbs.

Lexical Disorders
One of the least localization characteristics and yet most common clinical attributes in aphasia is the naming deficit.Such a deficit is defined as the inability or inconsistency in giving the appropriate name for an object, an action, and so on.This deficit is especially found in anomia aphasics.The naming disorder may also manifest itself in word difficulty, that is to say groping or searching for the appropriate word.This deficiency was well observed in two patients M and S for most of the time they reached an impasse in naming objects or actions.These examples from their speech show this difficulty:

The patient U…. udarli hadak
And and make(perfect) that (masc) And and made me that

Urradyu …..mana3rafch smiytu
And radio neg+I+know+neg name+poss(masc) The radio I don't know its name S encountered difficulties naming the action, so he used a vague verb dar (make), he also couldn't name the object, that's why he used hadak (that).
The lexical deficit may also manifest itself in empty speech which is characterized by the use of such non-specific words as anta3 (of) which was often used in the speech of M : The patient: Amsha :t labsa:t attabliya ' u: Go(perfect)+suffix 't' wear(perf)+t the apron and She went she wore the apron and In other cases, when she fails to find the right word, she uses other words that suggest function or use, as when she was shown a chair, she answered 'fu:q' (upon) to mean that it is used to 'sit on'.Sometimes, her answer is influenced by the preceding one: Orthophonist In the task of repetition, patients were given words and sentences and were asked to repeat them.To carry out this task, some patients proved more skilful than others.(A), for instance, had no difficulty in repeating words, but when it came to sentences the task became much harder: Orthophonist The problem of (F) is due to damage to the arcuate fasciculus which is a band of fibers that link Broca's area and Wernicke's area.Patients who suffer from this damage are unable to repeat the speech they hear because the auditory information reaching Wernicke's area cannot be conducted to Broca's area.As a consequence, the aphasia they suffer from is referred to as conduction aphasia.
noun morphemes, though omissions of free-standing grammatical morphemes, such as prepositions, occurred frequently.The speech of Broca's aphasics is generally non-fluent and semi-telegraphic but shows a good retention of basic noun and verb morphemes, as well as determiners (these latters may be prefixed as for the definite article or suffixed as for the indefinite article in Standard Arabic, but in Moroccan Arabic, indefiniteness is generally expressed by its absence).These patients have also a tendency to use overgeneralization in the naming task.On the other hand, the speech of Wernicke's aphasics is more or less fluent and displays a wide range of inappropriate forms, such as the blank-filling expression nta:3 (of) and also nonsensical words, such as ab3asa in the speech of Fatna, but the use of bound morphemes was strikingly preserved, as in 3arfiha (verb know + you + she) and ma3arfahash ( negation + verb know in the perfective tense + I) taken from the speech of Fatna.Negation in Moroccan Arabic is most frequently expressed through the use of the discontinuous morpheme ma:….sh, which attaches to the verb after all other affixational operations have applied.
The morphology of verbs in Moroccan Arabic is very complex.They follow derived form patterns, and each form is conjugated into the perfect tense or the imperfect tense.The two tenses share the grammatical categories of person, number and gender (S.Mediouny, 2007:144-145).A set of suffixes is attached to the stem in the perfect tense; whereas the imperfect tense needs both suffixes and prefixes in accordance with number (prefixes in the singular and prefixes plus suffixes in the plural).But despite all this morphological complexity, both Broca's and Wernicke's aphasics retained the use of bound inflectional morphemes in their ouput.

Conclusion
The above findings suggest that some of the 'classical' views on agrammatism are in need of revision.Many studies have come up with premature conclusions with regard to typologically similar languages, hence the need for more cross-linguistic studies, especially that much research has been carried out primarily on English speaking aphasics.Omission of grammatical morphemes is not a universal phenomenon of agrammatism.
The above data showed a great preservation of bound inflectional morphemes in Moroccan Arabic aphasics' speech, which is consistent with the latest findings of Bates et al. (1987) concerning Italian and German aphasics and also the findings of D. Slobin (1991) concerning Turkish aphasics.All this suggests that patterns of language breakdown are not the same for typologically different languages.So, we cannot compare the patterns of a highly-inflected language like Arabic or Turkish with more familiar patterns such as those exhibited by the English language.Cross-linguistic studies have shown that language-specific features determine the pattern of omissions and substitutions found in brain-damaged subjects (Mimouni,73).In a language like English, for example, reducing an affixed word to its stem would result in another word (as in cats/cat or running/run), but in a language like Moroccan Arabic, where generally, stems are not well-formed words, stripping a word of its grammatical affixes would result in a non-word, and this is, probably, one of the reasons why grammatical affixes are not omitted in the speech of Moroccan-Arabic speaking aphasics.
In this environment error, a phoneme which can be accounted for by the influence of the surrounding phonological context can occur.These environment errors include metathesis in which two phonemes may interchange their respective places:

Table 6 .
Samples of the different error mechanisms involved in the phonemic transformations AppleWhen she gets help for the first phoneme she can quickly access the word.As for the patient (F), she was unable to name any of the objects she had been shown on pictures: She said that she knew the word,but she failed to know it.Besides that, she was all the time These patients had great difficulties accessing lexical items.Patients with such damage are said to have anomia or anomic aphasia.
repeating words such as dyal (of), ha:da: (this) and ana: (I).Her fluency and the use of nonsense words or (neologisms) indicate that she was indeed suffering from Wernicke's aphasia.Thus, if the last three patients had difficulties naming, this is mainly due to damage to Wernicke's area or damage to the supramarginal gyrus.