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Review of  Clinical Linguistics

Reviewer: Shari Epstein
Book Title: Clinical Linguistics
Book Author: Elisabetta Fava
Publisher: John Benjamins
Linguistic Field(s): Applied Linguistics
General Linguistics
Issue Number: 14.65

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Date: Fri, 27 Dec 2002 11:46:13 -0700
Subject: Review of Fava (ed) (2002), Clinical Linguistics: Theory and Applications

Author: Fava, Elisabetta, ed. (2002) Clinical Linguistics: Theory and
Applications in Speech Pathology and Therapy. Benjamins, xiv+353pp,
hardback ISBN 1-58811-223-3, $86.00, Current Issues in Linguistic
Theory 227.

Reviewer: Shari A. Epstein, University of Arizona

In her book, Clinical Linguistics: Theory and Applications in Speech
Pathology and Therapy, Elisabetta Fava brings together 17 papers presenting
research done on the language of clinical populations (ie. populations who
have been diagnosed with a language disorder). The underlying theme throughout
all of the papers is that the linguist is a scientist and therefore should
constantly reevaluate linguistic theories in light of new data. In this
way, clinical data can illuminate not only the underlying functions of disordered
language, but also affect how we understand those of normal language.
One of the greatest strengths of this collection is that it draws from
many languages. This allows a particular disorder to be examined in different
linguistic contexts and for theories to be tested on languages other than
those with which they were developed. For example, Specific Language Impairment
(SLI) is studied by different researchers in children speaking Dutch, Greek,
Zulu, and Japanese. Theories can be tested by using languages especially
suited for a particular question and conclusions can therefore be drawn across
languages. Of course, there is an inherent danger in doing so. Namely,
it relies upon the assumption that a given disorder presents in the same
way, and is indeed the same disorder, regardless of the language spoken (for
further discussion of this, see the chapter by Tanaka Welty, Watanabe, &
Menn). However, the fact that a disorder can be studied in very different
linguistic contexts in and of itself supports the idea that the disorder
is independent of a specific language. In addition, disorders linked to
biological causes, for example brain lesions in the case of aphasia, should
share certain characteristics across languages.
Unfortunately, Fava does not take complete advantage of the organization
of her collection. While the chapters are grouped by topic allowing the
reader to better integrate the points made; Fava herself does not discuss
them as a group in a meaningful way. Even in her introduction, each paper
is discussed individually with only a single paragraph linking their general
ideas. Conclusions from one paper are not synthesized with those from another.
The grouping allows the reader to draw her/his own impressions but more
in-depth discussions of each section as a section would have also been quite

The first section, Phonology in Clinical Applications, contains two
papers. Both begin with a phonological theory and then use clinical data
to support it by showing that the theory is able to explain the data. The
first paper is Yishai Tobin's 'Phonology as human behavior: Theoretical
implications and cognitive and clinical applications'. Unlike most of the
papers in the collection, this paper did not use a disordered population
but rather a normally developing one that has not fully mastered spoken language.
In it, Tobin discussed the theory of Phonology as Human Behavior (PHB) and
used it to explain clinical patterns found in children who make phonological
errors. PHB states that there is conflict between the desire for maximum
communication and minimum effort. Therefore, Tobin argued, the phonological
errors can be explained reducing effort at the expense of communication.
It is only when there is a break down in communication that a child would
need to correct her/his errors.
Tobin's paper is followed by one by Dirk-Bart den Ouden entitled 'Segmental
vs syllable markedness: Deletion errors in the paraphasias of fluent and
non-fluent aphasic'. Different patterns of errors were found for fluent
and non-fluent aphasics indicating a different in the adherence to markedness
which was explained using Optimality Theory (OT). While a statistically
significance difference was found between the two types of aphasia, there
was still variation within each type. This, while not stated in the paper,
may have been due to subjects' having different degrees of aphasia.

Three papers make up the second section, Words in Deafness and Stuttering.
It is not clear why these two populations were put together except that
both are presented as performance, but not language disorders. In the paper
regarding deafness, Roberto Ajello, Giovanna Marotta, Laura Mazzoni, and
Florida Nicolai looked at the morphological errors made by Italian adults
with profound deafness in their paper, 'Morphosyntactic fragility in the
spoken and written Italian of the deaf'. Both spoken and written samples
were collected and analyzed. It was found that morphological skills were
significantly below lexical skills indicating that grammatical morphemes
posed a particular problem for this population.
The EXPLAN theory was applied to both the diagnosis of stuttering (Peter
Howell and James Au-Yeung's 'The EXPLAN theory of fluency control applied
to the diagnosis of stuttering') and the treatment of stuttering (Peter Howell's
'The EXPLAN theory of fluency control applied to the treatment of stuttering').
According to this theory, occasionally the planning for a word will not
have been completed by the time the word should be spoken. Compensatory
techniques include pausing and repeated the previous word. In those who
stutter, often the individual will attempt to say the word with an incomplete
plan risking a fluency failure. Therefore, therapy exercises that teach
the individual to slow down her/his rate of speech are often successful because
they allow a greater planning time for each word. This paper offered a good
example of how linguistic theory can be directly applied clinically in addition
to clinical data being applied to the theory.

The third section, Morphology and Syntax in Child Language Disorders,
is much more cohesive than the second. The four papers in it all address
specific language impairment (SLI) in different linguistic populations.
Because different languages have different morphological and syntactic rules,
cases of SLI should present differently depending on the language spoken
yet similarly enough to be treated as cases of the same disorder. In addition,
certain languages lend themselves to the testing of general hypotheses about
SLI because they either have or lack specific types of rules.
Roelien Bastaiaanse, Gerard Bol, Sofie van Mol, and Shalom Zuckerman's
paper entitled 'Verb movement and finiteness in language impairment and language
development' compared the production of finite verbs in Dutch by normally
developing children, children with SLI, and adults with agrammatic aphasia.
They found that it was not the actual production of the finite verbs that
was difficult for these populations but the verb movement suggesting syntactic
rather than morphological impairment. However, the different populations
did not compensate in the same way. The SLI group compensated in a way that
was similar to a hybrid of the other two in that their compensations contained
features of compensations made by normally developing children and by agrammatic
adults. Further support for a syntactic impairment in SLI is found in 'A-bar
movement constructions in Greek children with SLI: Evidence for deficits
in the syntactic component of language' by Stavroula Stavrakaki. Again,
it was the movement of verbs that emerged as a key impairment.
Susan Suzman's 'Morphological accessibility in Zulu' took a different
approach by focusing on morphology rather than syntax. Zulu, being a highly
inflected language, offers several opportunities in which to study impaired
morphology. Because of this difference, Suzman argued that children, even
those with SLI, who speak Zulu did not use uninflected verbs and did not
appear to have difficulty with agreements. This was in marked contrast to
English-speaking children with SLI and reinforced the idea that morphology
itself is not necessarily affected by SLI.
Japanese, like Zulu, allows SLI to be further teased apart. In fact,
Japanese is so different from most other languages in which SLI has been
studied that Yumiko Tanaka Welty, Jun Watanabe, and Lise Menn ('Language
production in Japanese preschoolers with specific language impairment: Testing
theories') first established whether SLI can even exist in a Japanese-speaking
population. Indeed, their findings did not support any of the hypotheses
of SLI which they set out to test leading them to form a cognitive overload
account of SLI.

Issues on Grammar and Cognition are explored in the three papers in
the fourth section. The relationship between language and cognition is one
that must be delineated both in clinical and research paradigms. Leah R.
Paltiel-Gedalyovich, in 'Testing linguistic concepts: Are we testing semantics,
syntax or pragmatics?', raised the question of what exactly standardized
language tests test. Since all tests of language must involve cognition
to some extent, there is a risk that what is called a language impairment
by the test may actually be a cognitive impairment. Specifically, a child
with an impairment in pragmatics might be labeled as having a language impairment
(eg. SLI) because she/he missed a significant percentage of the test items.
Modularity is an important word when discussing the relationship between
language and cognition. Simply put: Is language a separate function or
does it make use of processes that overlap with non-linguistic functions?
Dusana Rybarova explored this by focusing on SLI ('Specific language impairment
and modularity: Linguistic and non-linguistic explanations'). She argued
that by using a model of 'weak modularity', SLI can be described in a way
that addresses both linguistic and non-linguistic contributions to language.
SLI was compared to Williams syndrome as a way to separate language and
cognition in Vesna Stojanovik, Mick Perkins and Sara Howard's paper, 'The
language/cognition interface: Lessons from SLI and Williams syndrome'.
In SLI, language performance is significantly below that of cognition whereas
in Williams syndrome, the reverse is true. Stojanovik, Perkins, and Howard's
findings argued against a clear split between language and cognition (what
Rybarova described as 'strong modularity'). Instead, correct language use,
supporting the findings of Paltiel-Gedalyovich, was reliant upon both linguistic
and cognitive functioning.

The fifth and final section (Grammatical Structure in Aphasia), containing
five papers, is the largest. In the first paper, 'Grammar and fluent aphasia',
Susan Edwards studied the grammatical errors made by four subjects with fluent
aphasia (Wernicke's aphasia). Usually this type of lesion is associated
with word-retrieval errors. However, Edwards was able to show that not all
of the errors were the result of a lexical impairment. Rather, she argued
that there was limited access to grammatical processes as well.
Anna Gavarro looked at grammar by studying language samples by individuals
with aphasia from a variety of languages in 'Failure to agree in agrammatism'.
This paper used previously collected samples to test several linguistic
theories and provided a model for doing so. In addition, it demonstrated
the role theory has in the collection and organization of data. Not only
is this paper interesting for what it had to say about agrammatism, it offered
several insights to the relationship between language samples and theories.
'The Verb and Sentence Test: Assessing verb and sentence comprehension
and production in aphasia' by Judith Rispens, Roelien Bastiaanse, and Susan
Edwards is one of the most clinically applicable papers in the collection.
It presented and evaluated specific tasks included in the Verb and Sentence
Test (VAST) to assess aphasia. As in the previous paper, emphasis was placed
on the role linguistic theory has on actual practice: The VAST included
only tasks that are supported by theory. This is useful because, as demonstrated
by the following paper, some errors may occur only as a result of another
impairment and therefore should not be assessed separately. According to
Esther Ruigendijk's 'Case assignment as an explanation for determiner omission
in German agrammatic speech', it was an impairment in the production of finite
verbs that led to other errors in determiner production. Even though all
ten of the subjects omitted determiners in spontaneous speech, most were
able to correctly produce them when given a verb.
The final paper in the collection is 'The role of verbal morphology
in aphasia during lexical access: Evidence from Greek' by Kyrana Tsapkini,
Gonia Jarema, and Eva Kehayia. Unlike the previous papers which focused
on grammar in aphasia, this paper examines lexical access. This is in marked
contrast, for example, to 'Grammar and fluent aphasia' by Susan Edwards which
tried to remove lexical access as a factor. Together, these papers complement
each other.

As demonstrated, even though each of the papers is interesting in and
of itself, the real value of the collection is in the integration of the
various ideas presented. It is in this way that the reader will be able
to gain a richer understanding of the field as a whole. In addition, ideas
from one section can be constructively applied to those from another. The
overlap in ideas found in the SLI and aphasia sections is the most apparent,
although certainly not the only, example of this. Even without this, however,
Fava's Clinical Linguistics: Theory and Applications in Speech Pathology
and Therapy is both useful and instructive.
Shari Epstein is currently working towards a MS in speech-language pathology
at the University of Arizona. She holds a BA from Washington University
in St. Louis. Her interests include language disorders in children and the
application of research from various fields including linguistics, psychology,
and neurology to language disorders.