Learning from errors: Exploration of the monitoring learning effect.

The present study examined spontaneous detection and repair of naming errors in people with aphasia to advance a theoretical understanding of how monitoring impacts learning in lexical access. Prior work in aphasia has found that spontaneous repair, but not mere detection without repair, of semantic naming errors leads to improved naming on those same items in the future when other factors are accounted for. The present study sought to replicate this finding in a new, larger sample of participants and to examine the critical role of self-generated repair in this monitoring learning effect. Twenty-four participants with chronic aphasia with naming impairment provided naming responses to a 660-item corpus of common, everyday objects at two timepoints. At the first timepoint, a randomly selected subset of trials ended in experimenter-provided corrective feedback. Each naming trial was coded for accuracy, error type, and for any monitoring behavior that occurred, specifically detection with repair (i.e., correction), detection without repair, and no detection. Focusing on semantic errors, the original monitoring learning effect was replicated, with enhanced accuracy at a future timepoint when the first trial with that item involved detection with repair, compared to error trials that were not detected. This enhanced accuracy resulted from learning that arose from the first trial rather than the presence of repair simply signifying easier items. A second analysis compared learning from trials of self-corrected errors to that of trials ending in feedback that were detected but not self-corrected and found enhanced learning after self-generated repair. Implications for theories of lexical access and monitoring are discussed.

Mapping articulatory and grammatical subcomponents of fluency deficits in post-stroke aphasia.

Fluent speech production is a critical aspect of language processing and is central to aphasia diagnosis and treatment. Multiple cognitive processes and neural subsystems must be coordinated to produce fluent narrative speech. To refine the understanding of these systems, measures that minimize the influence of other cognitive processes were defined for articulatory deficits and grammatical deficits. Articulatory deficits were measured by the proportion of phonetic errors (articulatory and prosodic) in a word repetition task in 115 participants with aphasia following left hemisphere stroke. Grammatical deficits were assessed in 46 participants based on two measures-proportion of closed class words and proportion of words in sentences-generated during semistructured narrative speech production (telling the Cinderella story). These measures were used to identify brain regions critical for articulatory and grammatical aspects of speech production using a multivariate lesion-symptom mapping approach based on support vector regression. Phonetic error proportion was associated with damage to the postcentral gyrus and the inferior parietal lobule (particularly the supramarginal gyrus). Proportion of closed class words in narrative speech did not have consistent lesion correlates. Proportion of words in sentences was strongly associated with frontal lobe damage, particularly the inferior and middle frontal gyri. Grammatical sentence structuring relies on frontal regions, particularly the inferior and middle frontal gyri, whereas phonetic-articulatory planning and execution relies on parietal regions, particularly the postcentral and supramarginal gyri. These results clarify and extend current understanding of the functional components of the frontoparietal speech production system.

The parietal lobe and language.

Although the parietal lobe was considered by many of the earliest investigators of disordered language to be a major component of the neural systems instantiating language, most views of the anatomic substrate of language emphasize the role of temporal and frontal lobes in language processing. We review evidence from lesion studies as well as functional neuroimaging, demonstrating that the left parietal lobe is also crucial for several aspects of language. First, we argue that the parietal lobe plays a major role in semantic processing, particularly for "thematic" relationships in which information from multiple sensory and motor domains is integrated. Additionally, we review a number of accounts that emphasize the role of the left parietal lobe in phonologic processing. Although the accounts differ somewhat with respect to the nature of the linguistic computations subserved by the parietal lobe, they share the view that the parietal lobe is essential for the processes by which sound-based representations are transcoded into a format that can drive action systems. We suggest that investigations of the linguistic capacities of the parietal lobe constrained by the understanding of the parietal lobe in action and multimodal sensory integration may serve to enhance not only our understanding of language, but also the relationship between language and more basic brain functions.

Enhanced estimations of post-stroke aphasia severity using stacked multimodal predictions.

The severity of post-stroke aphasia and the potential for recovery are highly variable and difficult to predict. Evidence suggests that optimal estimation of aphasia severity requires the integration of multiple neuroimaging modalities and the adoption of new methods that can detect multivariate brain-behavior relationships. We created and tested a multimodal framework that relies on three information sources (lesion maps, structural connectivity, and functional connectivity) to create an array of unimodal predictions which are then fed into a final model that creates "stacked multimodal predictions" (STAMP). Crossvalidated predictions of four aphasia scores (picture naming, sentence repetition, sentence comprehension, and overall aphasia severity) were obtained from 53 left hemispheric chronic stroke patients (age: 57.1 ± 12.3 yrs, post-stroke interval: 20 months, 25 female). Results showed accurate predictions for all four aphasia scores (correlation true vs. predicted: r = 0.79-0.88). The accuracy was slightly smaller but yet significant (r = 0.66) in a full split crossvalidation with each patient considered as new. Critically, multimodal predictions produced more accurate results that any single modality alone. Topological maps of the brain regions involved in the prediction were recovered and compared with traditional voxel-based lesion-to-symptom maps, revealing high spatial congruency. These results suggest that neuroimaging modalities carry complementary information potentially useful for the prediction of aphasia scores. More broadly, this study shows that the translation of neuroimaging findings into clinically useful tools calls for a shift in perspective from unimodal to multimodal neuroimaging, from univariate to multivariate methods, from linear to nonlinear models, and, conceptually, from inferential to predictive brain mapping. Hum Brain Mapp 38:5603-5615, 2017. © 2017 Wiley Periodicals, Inc.

The timing of spontaneous detection and repair of naming errors in aphasia.

This study examined the timing of spontaneous self-monitoring in the naming responses of people with aphasia. Twelve people with aphasia completed a 615-item naming test twice, in separate sessions. Naming attempts were scored for accuracy and error type, and verbalizations indicating detection were coded as negation (e.g., "no, not that") or repair attempts (i.e., a changed naming attempt). Focusing on phonological and semantic errors, we measured the timing of the errors and of the utterances that provided evidence of detection. The effects of error type and detection response type on error-to-detection latencies were analyzed using mixed-effects regression modeling. We first asked whether phonological errors and semantic errors differed in the timing of the detection process or repair planning. Results suggested that the two error types primarily differed with respect to repair planning. Specifically, repair attempts for phonological errors were initiated more quickly than repair attempts for semantic errors. We next asked whether this difference between the error types could be attributed to the tendency for phonological errors to have a high degree of phonological similarity with the subsequent repair attempts, thereby speeding the programming of the repairs. Results showed that greater phonological similarity between the error and the repair was associated with faster repair times for both error types, providing evidence of error-to-repair priming in spontaneous self-monitoring. When controlling for phonological overlap, significant effects of error type and repair accuracy on repair times were also found. These effects indicated that correct repairs of phonological errors were initiated particularly quickly, whereas repairs of semantic errors were initiated relatively slowly, regardless of their accuracy. We discuss the implications of these findings for theoretical accounts of self-monitoring and the role of speech error repair in learning.

Towards a Theory of Learning for Naming Rehabilitation: Retrieval Practice and Spacing Effects.

Purpose: The purpose of this article was to examine how different types of learning experiences affect naming impairment in aphasia. Methods: In 4 people with aphasia with naming impairment, we compared the benefits of naming treatment that emphasized retrieval practice (practice retrieving target names from long-term memory) with errorless learning (repetition training, which preempts retrieval practice) according to different schedules of learning. The design was within subjects. Items were administered for multiple training trials for retrieval practice or repetition in a spaced schedule (an item's trials were separated by multiple unrelated trials) or massed schedule (1 trial intervened between an item's trials). In the spaced condition, we studied 3 magnitudes of spacing to evaluate the impact of effortful retrieval during training on the ultimate benefits conferred by retrieval practice naming treatment. The primary outcome was performance on a retention test of naming after 1 day, with a follow-up test after 1 week. Results: Group analyses revealed that retrieval practice outperformed errorless learning, and spaced learning outperformed massed learning at retention test and at follow-up. Increases in spacing in the retrieval practice condition yielded more robust learning of retrieved information. Conclusion: This study delineates the importance of retrieval practice and spacing for treating naming impairment in aphasia.

Does naming accuracy improve through self-monitoring of errors?

This study examined spontaneous self-monitoring of picture naming in people with aphasia. Of primary interest was whether spontaneous detection or repair of an error constitutes an error signal or other feedback that tunes the production system to the desired outcome. In other words, do acts of monitoring cause adaptive change in the language system? A second possibility, not incompatible with the first, is that monitoring is indicative of an item's representational strength, and strength is a causal factor in language change. Twelve PWA performed a 615-item naming test twice, in separate sessions, without extrinsic feedback. At each timepoint, we scored the first complete response for accuracy and error type and the remainder of the trial for verbalizations consistent with detection (e.g., "no, not that") and successful repair (i.e., correction). Data analysis centered on: (a) how often an item that was misnamed at one timepoint changed to correct at the other timepoint, as a function of monitoring; and (b) how monitoring impacted change scores in the Forward (Time 1 to Time 2) compared to Backward (Time 2 to Time 1) direction. The Strength hypothesis predicts significant effects of monitoring in both directions. The Learning hypothesis predicts greater effects in the Forward direction. These predictions were evaluated for three types of errors--Semantic errors, Phonological errors, and Fragments--using mixed-effects regression modeling with crossed random effects. Support for the Strength hypothesis was found for all three error types. Support for the Learning hypothesis was found for Semantic errors. All effects were due to error repair, not error detection. We discuss the theoretical and clinical implications of these novel findings.

Automated segmentation of chronic stroke lesions using LINDA: Lesion identification with neighborhood data analysis.

The gold standard for identifying stroke lesions is manual tracing, a method that is known to be observer dependent and time consuming, thus impractical for big data studies. We propose LINDA (Lesion Identification with Neighborhood Data Analysis), an automated segmentation algorithm capable of learning the relationship between existing manual segmentations and a single T1-weighted MRI. A dataset of 60 left hemispheric chronic stroke patients is used to build the method and test it with k-fold and leave-one-out procedures. With respect to manual tracings, predicted lesion maps showed a mean dice overlap of 0.696 ± 0.16, Hausdorff distance of 17.9 ± 9.8 mm, and average displacement of 2.54 ± 1.38 mm. The manual and predicted lesion volumes correlated at r = 0.961. An additional dataset of 45 patients was utilized to test LINDA with independent data, achieving high accuracy rates and confirming its cross-institutional applicability. To investigate the cost of moving from manual tracings to automated segmentation, we performed comparative lesion-to-symptom mapping (LSM) on five behavioral scores. Predicted and manual lesions produced similar neuro-cognitive maps, albeit with some discussed discrepancies. Of note, region-wise LSM was more robust to the prediction error than voxel-wise LSM. Our results show that, while several limitations exist, our current results compete with or exceed the state-of-the-art, producing consistent predictions, very low failure rates, and transferable knowledge between labs. This work also establishes a new viewpoint on evaluating automated methods not only with segmentation accuracy but also with brain-behavior relationships. LINDA is made available online with trained models from over 100 patients.

The Marin Lab at the Dawn of Cognitive Neuropsychology.

This essay discusses the intellectual developments in psychology, linguistics, and behavioral neurology that shaped Oscar Marin's approach to disorders of high cortical function. As Chief of Neurology at Baltimore City Hospitals in the 1970s, Dr Marin teamed with biopsychologist Eleanor Saffran and the author in seminal studies of acquired language disorders (aphasia) centering on core processes of syntax and semantics, and rejecting premature reductionism. The philosophical and methodological principles that motivated these studies are traced through the author's personal recollections and the published writings of the Marin lab. These principles came to be associated with the cognitive neuropsychology school of research and have important linkages to contemporary work in the neuroscience of aphasia and related cognitive disorders.

Neural organization of spoken language revealed by lesion-symptom mapping.

Studies of patients with acquired cognitive deficits following brain damage and studies using contemporary neuroimaging techniques form two distinct streams of research on the neural basis of cognition. In this study, we combine high-quality structural neuroimaging analysis techniques and extensive behavioural assessment of patients with persistent acquired language deficits to study the neural basis of language. Our results reveal two major divisions within the language system-meaning versus form and recognition versus production-and their instantiation in the brain. Phonological form deficits are associated with lesions in peri-Sylvian regions, whereas semantic production and recognition deficits are associated with damage to the left anterior temporal lobe and white matter connectivity with frontal cortex, respectively. These findings provide a novel synthesis of traditional and contemporary views of the cognitive and neural architecture of language processing, emphasizing dual routes for speech processing and convergence of white matter tracts for semantic control and/or integration.

The ins and outs of meaning: Behavioral and neuroanatomical dissociation of semantically-driven word retrieval and multimodal semantic recognition in aphasia.

Theories about the architecture of language processing differ with regard to whether verbal and nonverbal comprehension share a functional and neural substrate and how meaning extraction in comprehension relates to the ability to use meaning to drive verbal production. We (re-)evaluate data from 17 cognitive-linguistic performance measures of 99 participants with chronic aphasia using factor analysis to establish functional components and support vector regression-based lesion-symptom mapping to determine the neural correlates of deficits on these functional components. The results are highly consistent with our previous findings: production of semantic errors is behaviorally and neuroanatomically distinct from verbal and nonverbal comprehension. Semantic errors were most strongly associated with left ATL damage whereas deficits on tests of verbal and non-verbal semantic recognition were most strongly associated with damage to deep white matter underlying the frontal lobe at the confluence of multiple tracts, including the inferior fronto-occipital fasciculus, the uncinate fasciculus, and the anterior thalamic radiations. These results suggest that traditional views based on grey matter hub(s) for semantic processing are incomplete and that the role of white matter in semantic cognition has been underappreciated.

Test-enhanced learning versus errorless learning in aphasia rehabilitation: testing competing psychological principles.

Because individuals with acquired language disorders are frequently unable to reliably access the names of common everyday objects (i.e., naming impairment), rehabilitation efforts often focus on improving naming. The present study compared 2 rehabilitation strategies for naming impairment, reflecting contradictory prescriptions derived from different theoretical principles. The prescription derived from psychological research on test-enhanced learning advocates providing patients opportunities to retrieve target names from long-term memory (i.e., retrieval practice) in the course of treatment. In contrast, the errorless learning approach derived from cognitive rehabilitation research eschews retrieval practice in favor of methods that minimize naming errors, and thus the potential for error learning, in the course of treatment. The present study directly compared these approaches and showed that, despite superior (and errorless) performance during errorless treatment, treatment that prioritized retrieval practice produced greater retention 1-day and 1-week following treatment. These findings have implications for clinical practice, as well as theoretical accounts of lexical access and test-enhanced learning.

Multivariate lesion-symptom mapping using support vector regression.

Lesion analysis is a classic approach to study brain functions. Because brain function is a result of coherent activations of a collection of functionally related voxels, lesion-symptom relations are generally contributed by multiple voxels simultaneously. Although voxel-based lesion-symptom mapping (VLSM) has made substantial contributions to the understanding of brain-behavior relationships, a better understanding of the brain-behavior relationship contributed by multiple brain regions needs a multivariate lesion-symptom mapping (MLSM). The purpose of this artilce was to develop an MLSM using a machine learning-based multivariate regression algorithm: support vector regression (SVR). In the proposed SVR-LSM, the symptom relation to the entire lesion map as opposed to each isolated voxel is modeled using a nonlinear function, so the intervoxel correlations are intrinsically considered, resulting in a potentially more sensitive way to examine lesion-symptom relationships. To explore the relative merits of VLSM and SVR-LSM we used both approaches in the analysis of a synthetic dataset. SVR-LSM showed much higher sensitivity and specificity for detecting the synthetic lesion-behavior relations than VLSM. When applied to lesion data and language measures from patients with brain damages, SVR-LSM reproduced the essential pattern of previous findings identified by VLSM and showed higher sensitivity than VLSM for identifying the lesion-behavior relations. Our data also showed the possibility of using lesion data to predict continuous behavior scores.

Theoretical analysis of word production deficits in adult aphasia.

The cognitive analysis of adult language disorders continues to draw heavily on linguistic theory, but increasingly it reflects the influence of connectionist, spreading activation models of cognition. In the area of spoken word production, 'localist' connectionist models represent a natural evolution from the psycholingistic theories of earlier decades. By contrast, the parallel distributed processing framework forces more radical rethinking of aphasic impairments. This paper exemplifies these multiple influences in contemporary cognitive aphasiology. Topics include (i) what aphasia reveals about semantic-phonological interaction in lexical access; (ii) controversies surrounding the interpretation of semantic errors and (iii) a computational account of the relationship between naming and word repetition in aphasia. Several of these topics have been addressed using case series methods, including computational simulation of the individual, quantitative error patterns of diverse groups of patients and analysis of brain lesions that correlate with error rates and patterns. Efforts to map the lesion correlates of nonword errors in naming and repetition highlight the involvement of sensorimotor areas in the brain and suggest the need to better integrate models of word production with models of speech and action.

Support vector regression based multivariate lesion-symptom mapping.

A novel multivariate lesion-symptom mapping (LSM) methodology was developed in this study. Lesion analysis is a classic model for studying brain functions. Using lesion data, focal brain-behavior associations have been widely assessed using the massive voxel-based lesion symptom mapping (VLSM) method. Assessing each voxel independently, VLSM suffers from low sensitivity after correcting for the enormous number of comparisons. It is also incapable for assessing a spatially distributed association pattern though the brain-behavior associations generally involve a collection of functionally related voxels. To solve these two outstanding problems, we carried out the first multivariate lesion symptom mapping (MLSM) in this study using support vector regression (SVR). In the so dubbed SVR-LSM, the symptom relation to the entire lesion map rather than each isolated voxel is modeled using a non-linear function, so the inter-voxel correlations are intrinsically considered, resulting in a potentially more sensitive way to examine lesion-symptom relationships. Evaluations using synthetic data and real data showed that SVR-LSM gained a much better performance (in terms of sensitivity and specificity) for detecting brain-behavior relations than VLSM. While the method was designed for lesion analysis, extending it to neuroimaging data will be straightforward.

Learning to fail in aphasia: an investigation of error learning in naming.

PURPOSE: To determine whether the naming impairment in aphasia is influenced by error learning and whether error learning is related to type of retrieval strategy. METHOD: Nine participants with aphasia and 10 neurologically intact controls named familiar proper noun concepts. When experiencing tip-of-the-tongue naming failure (TOT) in an initial TOT-elicitation phase, participants were instructed to adopt phonological or semantic self-cued retrieval strategies. In the error learning manipulation, items evoking TOT states during TOT elicitation were randomly assigned to a short or long time condition in which participants were encouraged to continue to try to retrieve the name for either 20 s (short interval) or 60 s (long). The incidence of TOT on the same items was measured on a post-test after 48 hr. Error learning was defined as a higher rate of recurrent TOTs (TOT at both TOT elicitation and post-test) for items assigned to the long (versus short) time condition. RESULTS: In the phonological condition, participants with aphasia showed error learning, whereas controls showed a pattern opposite to error learning. There was no evidence for error learning in the semantic condition for either group. CONCLUSION: Error learning is operative in aphasia but is dependent on the type of strategy used during naming failure.

Voxel-based lesion-parameter mapping: Identifying the neural correlates of a computational model of word production.

The dual-route interactive two-step model explains the variation in the error patterns of aphasic speakers in picture naming, and word and nonword repetition tasks. The model has three parameters that can vary across individuals: the efficiency of the connections between semantic and lexical representations (s-weight), between lexical and phonological representations (p-weight), and between representations of auditory input and phonological representations (nl-weight). We determined these parameter values in 103 participants with chronic aphasia from left hemisphere stroke whose lesion locations had been determined. Then, using voxel-based lesion-parameter mapping, we mapped the parameters onto the brain, thus determining the neural correlates of the model's mechanisms. The maps and the behavioral findings supported the model's central claim that word repetition is affected by both the p and nl parameters. We propose that these two parameters constitute the model's analogue of the "dorsal stream" component of neurocognitive models of language processing.

The dorsal stream contribution to phonological retrieval in object naming.

Meaningful speech, as exemplified in object naming, calls on knowledge of the mappings between word meanings and phonological forms. Phonological errors in naming (e.g. GHOST named as 'goath') are commonly seen in persisting post-stroke aphasia and are thought to signal impairment in retrieval of phonological form information. We performed a voxel-based lesion-symptom mapping analysis of 1718 phonological naming errors collected from 106 individuals with diverse profiles of aphasia. Voxels in which lesion status correlated with phonological error rates localized to dorsal stream areas, in keeping with classical and contemporary brain-language models. Within the dorsal stream, the critical voxels were concentrated in premotor cortex, pre- and postcentral gyri and supramarginal gyrus with minimal extension into auditory-related posterior temporal and temporo-parietal cortices. This challenges the popular notion that error-free phonological retrieval requires guidance from sensory traces stored in posterior auditory regions and points instead to sensory-motor processes located further anterior in the dorsal stream. In a separate analysis, we compared the lesion maps for phonological and semantic errors and determined that there was no spatial overlap, demonstrating that the brain segregates phonological and semantic retrieval operations in word production.

Subdivision of frontal cortex mechanisms for language production in aphasia.

Ventrolateral prefrontal cortex (VLPFC) has long been linked to language production, but the precise mechanisms are still being elucidated. Using neuropsychological case studies, we explored possible sub-specialization within this region for different linguistic and executive functions. Frontal patients with different lesion profiles completed two sequencing tasks, which were hypothesized to engage partially overlapping components. The multi-word priming task tested the sequencing of co-activated representations and the overriding of primed word orders. The sequence reproduction task tested the sequencing of co-activated representations, but did not employ a priming manipulation. We compared patients' performance on the two tasks to that of healthy, age-matched controls. Results are partially consistent with an anterior-posterior gradient of cognitive control within lateral prefrontal cortex (Koechlin & Summerfield, 2007). However, we also found a stimulus-specific pattern, which suggests that sub-specialization might be contingent on type of representation as well as type of control signal. Isolating such components functionally and anatomically might lead to a better understanding of language production deficits in aphasia.

Short-form Philadelphia naming test: rationale and empirical evaluation.

PURPOSE: To create two matched short forms of the Philadelphia Naming Test (PNT; Roach, Schwartz, Martin, Grewal, & Brecher, 1996) that yield similar results to the PNT for measuring anomia. METHOD: In Study 1, archived naming data from 94 individuals with aphasia were used to identify which PNT items should be included in the short forms. The 2 constructed sets of 30 items, PNT30-A and PNT30-B, were validated using archived data from a separate group of 56 individuals with aphasia. In Study 2, the reliability of the PNT, PNT30-A, and PNT30-B across independent test administrations was evaluated with a new group of 25 individuals with aphasia who were selected to represent the full range of naming impairment. RESULTS: In Study 1, PNT30-A and PNT30-B were found to be internally consistent, and accuracy scores on these subsets of items were highly correlated with the full PNT. In Study 2, PNT accuracy was extremely reliable over the span of 1 week, and independent administrations of PNT30-A and PNT30-B produced similar results to the PNT and to each other. CONCLUSION: The short forms of the PNT can be used to reliably estimate PNT performance, and the results can be compared to the provided norms. The 2 matched tests allow for the measurement of change in an individual's naming ability.