The first three years of human life are key to the development and acquisition of speech and language skills. Skills that, in principle, will accompany the person for the rest of his or her existence.

But there are cases in which this capacity is truncated due to lesions in certain regions of the brain; thus appearing aphasic disorders that lead to deficits such as agramaticism, which will be discussed throughout this article .

What is agramaticism?

Agramaticism is considered an alteration of the language proper to aphasias . Its most outstanding feature is that the person presents a linguistic deficit which is shown by faults referring to morphological structures. That is, it presents a great difficulty to join words in a sentence forming syntactically appropriate sequences.

This failure usually appears in patients diagnosed with Broca’s Aphasia. The fact that it manifests itself as a difficulty in creating syntactic constructs makes it considered one more symptom within this type of aphasia.

However, after the development of cognitive neuropsychology in the mid-twentieth century, it became clear that agramaticism was something much more complex and that it could be observed in patients who did not meet the other requirements for the classic diagnosis of Broca’s aphasia. In addition, individual differences between patients were more than noticeable.

At that very moment an immense debate was opened about whether agramaticism could be considered a validated aphasic category. This controversy still continues today, with disagreement between those who advocate agramaticism as an aphasic syndrome and those who oppose its validity as such.

But what are aphasias?

According to the general definition of aphasia, it refers to a language disorder caused by brain damage in one of the language areas, which makes the person unable to communicate through speech, writing, and even mimicry.

The causes of aphasia can be:

  • Stroke
  • Head trauma
  • Brain infection
  • Neoplasia
  • Degenerative process

On the other hand, if we focus on the definition of Broca’s aphasia, it is characterized by the practical impossibility of achieving a fluid verbal production and by the use of short sentences and grammars produced with an enormous effort and in a prosodic way.

Symptoms

There are a number of symptoms that are shown more or less consistently in the understanding and production of agrammatic patients.

1. Symptoms associated with language production

These are the most common symptoms associated with speech.

1.1. Problems in grammatical morphemes

This symptom is reflected in the selective omission of both free and linked grammatical morphemes . However, this symptom as such is more typical of English-speaking patients, who add inflections to words. But in languages such as Spanish or Italian it is not possible, since the inflections are added to the roots.

For example, in the English language you can omit -ed in the word walk, but a Spanish-speaking person cannot omit -ía in comía, since it will no longer be a word but a sound without meaning.

In view of this fact, the omission of free grammatical morphemes and the substitution or omission of linked grammatical morphemes according to language was considered to be typical of agramaticism.

1.2. Mean length of the orational emission

One of the symptoms seen in the agramaticism, but not always present, is reduced oral emission length. In which patients express themselves through much shorter than usual expressions and phrases.

1.3. Name-Verb Dissociation

Another symptom of people with agramaticism is difficulty in accessing verbal forms. That is, patients omit or nominate the main verbs of sentences.

This deficit is present both in structured tasks and in tasks of spontaneous oral production.

1.4. Difficulties in building sentences

These patients use subject-verb-object structures; presenting an enormous difficulty in sentences of greater syntactic complexity. This symptom is a consequence of a lexical deficit that affects the correct selection of verbs.

1.5. Problems with word order

It is considered one of the most characteristic features of agramaticism. Agrammatics patients present difficulties in correctly ordering verbal expressions according to an understandable order, especially in the production of passive phrases or with different structures from the usual ones.

2. Symptoms associated with linguistic understanding

Until the 1970s, agramaticism was considered to be an exclusive deficit of language production, regardless of whether linguistic understanding was altered.

But research on the auditory understanding of programmatics has revealed that these patients show difficulties in some specific syntactic components , which prevent them from understanding some sentence structures. The alteration is selective since the patients present a great deterioration in the comprehension of certain sentences, but the rest of the syntax remains intact.

Evaluation and diagnosis

Despite the complexity of this deficit, there is no specific evidence to evaluate it; being the tests of aphasia evaluation the most used.

Currently, the subtests of the Boston and Barcelona tests concerning verbal expression are used : narration of an event and description of an image. The assessment includes the transcription of the patient’s speech with the consequent evaluation of lexical poverty, the quality of syntagmas, the incorrect use of morphemes and lexemes, or the incorporation of functional words.

1. Boston Aphasia Diagnostic Test (Goodlas and Kaplan, 1972)

It is the most widely used test given its ease of administration. It contains a specific vocabulary assessment test, and an abbreviated format for quick patient screening.

2. Barcelona Test (Peña-Casanova, 1990)

This test assesses all cognitive mechanisms related to language. It is characterized as a long and complicated test but it has an abbreviated format.

Treatment: HELPSS method

The beginnings of this method were based on certain studies of agramaticism, in which story completion techniques were used in patients with Broca’s aphasia and agrammatics.

In addition, this method integrated different levels of difficulty into the story completion activities . Thus, the HELPSS methodology includes a succession of stages ordered in a hierarchical way in two levels of difficulty: A and B; working, in addition, with eleven types of sentences:

  • Transitive imperative
  • Intransitive imperative
  • Transitive Declarative
  • Interrogative Pronominal
  • Transitive Declarative
  • Declarative intransitive
  • Comparison
  • Passive
  • Direct and indirect object
  • Yes/no questions
  • Subordinate Prayers
  • Future

Each type of sentence is worked on at both levels of difficulty, presenting twenty stories with different examples of the previous types of sentences, which are exemplified with images but not with written phrases.

During the A level, the professional must tell a story that ends with the image of it. The patient is then asked a question to obtain an answer from the East by means of an example. When the person reaches 90% of successes in a type of sentence, he or she moves on to level B of the sentence.

During Level B, the sample sentence is omitted; the patient must elaborate the sentence in a genuine way.