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Self-reported inner speech in aphasia is related to phonological retrieval

Mackenzie E. Fama1*, Sarah F. Snider1, William Hayward1, Rhonda B. Friedman1 and Peter E. Turkeltaub1, 2
  • 1 Georgetown University, United States
  • 2 MedStar National Rehabilitation Hospital, Research Division, United States

Many individuals with aphasia express frustration with speech abilities that fail to reflect internal knowledge of words, e.g., “I know it but I can’t say it.” Some claim specifically that they can say words correctly in their heads, despite being unable to do so out loud. Limited studies show evidence for preserved inner speech (IS) in some individuals with aphasia (Goodglass et al., 1976; Feinberg et al., 1986; Geva et al., 2011a; Geva et al., 2011b) but the subjective experience of “successful IS” (sIS) is understudied. In an ongoing study, we compare subjective reports of sIS to objective language measures to test the hypothesis that sIS arises from successful phonological retrieval and, when followed by overt anomia, reflects a deficit in post-lexical output processes. This project builds on pilot work showing relationships between sIS, phonological processing deficits, and lesions in ventral sensorimotor cortex (Hayward et al., 2016; Fama et al., 2017). Enrollment to date includes 39 adults with chronic left hemisphere stroke (>6 months post-onset): 17 women and 22 men, average age 61.5 years (SD=9.1), average education 16.3 years (SD=2.6), and average time since stroke 5.3 years (SD=4.9). All participants are required to meet an auditory comprehension inclusion criterion of least 48/60 on the Western Aphasia Battery Yes/No Questions subtest (Kertesz, 2006). Participants report the presence or absence of sIS for 120 items during a silent picture naming task. They also perform a battery of objective language tests to measure semantic and phonological access, verbal working memory, and speech production. The tests of primary interest are silent picture-based rhyme judgment, syllable counting, and first letter judgment. These IS-based tasks are each matched with an auditory version, so we can isolate the contribution of phonological retrieval (IS) to performance on these tasks by using a subtraction score: IS(performance) – Auditory(performance). We predict that self-ratings of sIS will have a positive relationship with these difference scores, which represent successful phonological retrieval. We also predict that sIS will have a negative relationship with measures of post-lexical output processing, such as phonological assembly and motor programming for articulation, as well as verbal working memory, a cognitive function that supports successful speech output. Relationships between sIS and behavioral scores are reported using partial correlations controlled for overt naming ability, single word auditory comprehension, and education (Table 1). As predicted, subjective reports of sIS were strongly correlated with difference scores on all three phonological retrieval tasks, providing strong support that subjective experience of sIS is reflective of successful phonological access to lexical items. Furthermore, the hypothesized relationship between sIS and post-lexical output processing deficits in individuals with anomia is supported by correlations with greater lexicality effect in repetition (where performance for real words exceeds performance for pseudowords, consistent with a deficit in output phonology), lower diadochokinetic (DDK) rates (production of rapidly alternating speech sounds), and poorer performance on backwards digit span (a measure of verbal working memory). Overall, this ongoing study confirms and extends prior findings suggesting that the subjective experience of sIS in aphasia is meaningful, that sIS is related to phonological retrieval, and that anomia after sIS is related to post-lexical output deficits.

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References

Fama, M. E., Hayward, W., Snider, S. F., Friedman, R. B., & Turkeltaub, P. E. (2017). Subjective experience of inner speech in aphasia: Preliminary behavioral relationships and neural correlates. Brain and Language, 164, 32–42.
Feinberg, T., Rothi, L., & Heilman, K. (1986). “Inner Speech” in Conduction Aphasia. Archives of Neurology, 43, 591–593.
Geva, S., Bennett, S., Warburton, E. A., & Patterson, K. (2011a). Discrepancy between inner and overt speech: Implications for post-stroke aphasia and normal language processing. Aphasiology, 25(3), 323–343.
Geva, S., Jones, P. S., Crinion, J. T., Price, C. J., Baron, J.-C., & Warburton, E. a. (2011b). The neural correlates of inner speech defined by voxel-based lesion-symptom mapping. Brain : A Journal of Neurology, 134(Pt 10), 3071–82.
Goodglass, H., Kaplan, E., Weintraub, S., & Ackerman, N. (1976). The “tip-of-the-tongue” phenomenon in aphasia. Cortex, 12, 145–153.
Hayward, W., Snider, S. F., Luta, G., Friedman, R. B., & Turkeltaub, P. E. (2016). Objective support for subjective reports of successful inner speech in two people with aphasia. Cognitive Neuropsychology, 3294(July), 1–16.
Kertesz, A. (2006). Western Aphasia Battery - Revised. San Antonio, TX: Pearson.

Keywords: inner speech, Anomia, Self-Monitoring, phonological processing, Aphasia

Conference: Academy of Aphasia 55th Annual Meeting , Baltimore, United States, 5 Nov - 7 Nov, 2017.

Presentation Type: poster or oral

Topic: Consider for student award

Citation: Fama ME, Snider SF, Hayward W, Friedman RB and Turkeltaub PE (2019). Self-reported inner speech in aphasia is related to phonological retrieval. Conference Abstract: Academy of Aphasia 55th Annual Meeting . doi: 10.3389/conf.fnhum.2017.223.00062

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Received: 21 Apr 2017; Published Online: 25 Jan 2019.

* Correspondence: Ms. Mackenzie E Fama, Georgetown University, Washington, DC, United States, mackenziefama@gmail.com