LANGUAGE MS patients. From this point of view,

LANGUAGE
ASPECTS OF PATIENTS WITH MULTIPLE SCLEROSIS

 

Ali
R?za SONKAYA, Zeynep Zeliha BAYAZIT

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Abstract

Multiple
Sclerosis (MS) is one of the most common chronic disease among the
neurodegeneretive disorders that kind of demyalinating disease of Central Nervous
System (CNS). The clinical course of MS can be relapsing-remmitting or
progressive. The disease especially causes damage to myelin layers and also
less of the axons. As a results of the damage some neurological impairments can
be seen, giving a symptomatology according to the forms of clinical phase
affecting the motor, sensory, cerebellar, cognitive, language functions, etc. Since
begining the identification of language functions abnormalities in MS, the
language performance evaluating provides the significant contribution to
physican in dignosis and follow-up of the MS patients. From this point of view,
the present study aims to investigate the language aspects of MS from
linguistic perspective.

Keywords:
Multiple sclerosis, language aspects, linguistic view

Introduction

MS
is one of the most common neurodegeneretive chronic disease of CNS which
characterised by a variety of symptoms that result from demyelination and
inflammation along axons in multiple regions in the brain and spinal cord (1,2).
The disease affects women more than twice as much as men. The age of onset
ranging is seen generally between 20 and 40 years (3). MS etiology is still
unknown but it is thought that MS is an autoimmune disease occurring in a
genetically susceptible individual triggered by environmental factors (4,5,6). Although
its course is unpredictable, clinical subgroups are identified. At clinical
onset, more than 85% of MS patients experience the exacerbation symptoms
followed by periods when symptoms remit or disappear (3,5). This kind of form is
called relapsing-remitting MS (RRMS). The other forms of MS are known primary
progressive MS (PPMS) and secondary progressive MS (SPMS).  

MS is influenced different areas in the brain, more particularly produces
lesions throughout the white matter, resulting in a range of neurological
deficits, affecting the motor, sensory, cerebellar, cognitive,
language functions, etc. Since begining the identification of language
functions abnormalities in MS, the language performance evaluating provides the
significant contribution to physican in dignosis and follow-up of the MS
patients.

Language
disorders in patients with MS can be sometimes disabling and they can manifest
themselves through motor speech aspects also known as dysarthria, respiratory
deficits, voice disorders like dysphonia, and high level of problems such as
comprehension and expression (7,8,9). In
clinical practices, generally health care professionals evaluate the language
aspects with naming and/or fluency tests (10) whereas linguistic theory suggest
that each facet of language be considered separately in order to come to a more
thorough diagnosis because simple naming and fluency tests, though revealing,
do not give a complete picture of language function (11). These tests may have
failed to identify more complex language processes. In the literature varios
studies have reported naming and fluency difficulties among the population of
MS (12,13). In addition, reduced speed of lexical access is another inconsistently
reported linguistic deficit (14). Morever, the majority of researches have
reported competent reading, writing, and spelling feats as well as relatively
intact comprehension skills in patients with MS. Inconsistent findings among
researchers make it difficult to draw tangible results about language aspects
in the population of MS.

It
is conceivable that the assesment of the pragmatic dimension of language
comprising the structural compenents of language which appears when language is
used to communicate in a social context may draw a better frame for MS language
aspects than naming and fluency tests. Using common clinical measures to
examine pragmatic language ability in patients with MS might help to better
characterize the language aspects by this population and suggest insight
regarding the conflictive findings produced by standardized testing. The
pragmatic use of language, has been less well studied in patients with MS
(10,11), and how they are affected still remains poorly understood. For this
reason the present study aims to investigate the language aspects of MS and
determine the language aspects derived from natural language samples through
the linguistic perspective.

Methods

Participants

This study was conducted on 35
subjects (22 males + 13 females) of chronological age between 18 and 60 years.
All subjects were diagnosed with RRMS according to 2010 McDonald criteria by a
professional neurologist. Participants with MS had no other
co-existing neurological disorder and had EDSS ? 3.5. The control group consisted of 35 subjects who matched
with experimental group of the same age and sex. Patients
with MS were initially contacted by a neurology policlinic in order to protect
patient privacy rights. All participants were native speakers of Turkish. They
were reported no history of speech therapy, no history of or current substance
abuse and also they were free from past or present use of antipsychotic
medication and did not use a hearing aid. Prior to the experiment all
participants were given an information about the research and taken to the study
who gave the consent.

 Data Production

All
participants were instructed to talk for twenty minutes about their life and
background to the neurologist. They were also explained that the neurologist
would only intervene if they became blocked. Thus, the pragmatic language
productions were almost undirected with the participant having full freedom of
speech. Whenever the participants stopped speaking for more than 5 seconds, the
neurologist asked questions to encourage speech production in the participant.  Such
questions were prefered open, instead of closed questions that can be answered
in a few words, so as to intervene as little as possible in the outputs of participants.
In sum, the interference by the neurologist was as short as possible. This
approach allows greater opportunity to observe an individual’s communication(16)  and also it may be ensure determining their
language aspects in clinical environment.

The
participants speechs were recorded using an digital voice recoder by the
neurologist in a quite room. Sound recordings were transcribed by the
researhers.according to procedures outlined in Systematic Analysis of Language
Transcripts (17) for subsequent analysis. Identification of language aspects were
obtained from the transcribed and recorded data from angle of phonology,
morphology, sytax, semantic and pragmatic respectively (Table 1).

 

 

 

 

                    Table   1. Description of Language
PMeasures

Linguistic system

                      Deficits
 

Phonology

Phonology
is the study of the sound system of language, and includes the rules that
govern its spoken form. Phonology analyzes which sound units are within a
language and examines how these sounds are arranged, their systematic
organization and rule system (18).

–        
Frequently appear as articulation disorders.
·        
Subject omits a consonant: “oo” for you
·        
Subject substitutes one consonant: “wabbit” for rabbit
·        
Discrimination: subject hears “go get the nail” instead of mail

Morphology

Morphology
is the study of the structure of words; it analyzes how words are built out
of morphemes, the basic unit of morphology. Morpheme is the smallest
meaningful unit of a language (18)

–        
Subject may not use appropriate inflectional endings
in their speech (e.g.,”He walk” or “Mommy coat”).
–        
Subject may lack irregular past tense or irregular
plurals (e.g., “drived” for “drove” or “mans” for “men”).
Be aware of “Black English”: “John cousin” “fifty cent”,
or “She work here”.

Syntax

Syntax
consists of organizational rules denoting word, phrase, and clause order. It
also examines the organization and relationship between words, word classes, grammar
of the language and other sentence elements (18)

–        
Lack the length
or syntactic complexity (e.g., “Where
Daddy go?”).
–        
Problems
comprehending sentences that express relationship between direct or indirect
objects.
Difficulty with wh questions.
Difficulty with
grammar of language (eg. ” mum went to
work everyday)

Semantic

Semantic
is the study of linguistic meaning and includes the meaning of words,
phrases, and sentences (18). 

–        
Limited
vocabulary especially in adjectives, adverbs, prepositions, or pronouns.
–        
Longer response
time in selecting vocabulary words.
–        
Fail to perceive
subtle changes in word meaning: incomplete understanding and
misinterpretations.
–        
Figurative
language problems.

Pragmatic

Pragmatic is the
study of knowledge and ability to use language functionally in social or
interactive situations and integrates all the other language skills, but also
requires knowledge and use of rule governing the use of language in social
context.
 

–        
Problems
understanding indirect requests (e.g., may say yes when asked “Must you play the piano?”).
–        
May enter
conversations in a socially unacceptable fashion or fail to take turns
talking.
–        
Difficulty
staying on topic.

 

According to linguistic
perspective phonology, morphology and syntax are constituted the forms of
language. Semantic states the content and pragmatic indicates the using of
language (Figure 1).

 

Figure 1. Language Components and Skills

 

Data analysis

The
first step in the analyses was to create composite measures from SALT analyses.
To examine the concordance language aspects between MS and healthy volunteer, linguistic
measures were derived from the speech data. A Linguistic composite was created
by phonetic,morphologic,syntactic,semantic and pragmatic.

Statical
analysis were carried out in SPSS 18. Evaluation of descriptive datas were used
t-test and The Mann–Whitney U test was used to search for comparing patients
with MS and healthy controls. p