The relation between oral movement control and speech.

A large series of neurological patients, selected solely on the basis that they had damage restricted to one hemisphere of the brain, was given a variety of tests of basic speech and praxic function. Within the left-damaged group, patients were further identified as aphasic or nonaphasic, based on preexisting standard tests of aphasia. Subgroups of aphasics were studied on the basis of lesion location, rather than on the basis of aphasia type. The focus of the study was the relation between the production of speech and nonspeech oral movements, particularly across anterior and posterior lesions. Reproduction of single nonverbal oral movements and of single isolated speech sounds was found to be very highly correlated, and both depended selectively on the left anterior region of the brain. This same region was critically important for rapid repeated articulation of a syllable, suggesting that it mediates control at some "unit" level of movement, in a phenomenological sense, for both speech and nonspeech movements. Other "speech" regions in the left hemisphere appeared to be dispensable for the production of single oral movements, whether these were verbal or nonverbal movements. However, for most aphasic patients, an area in the left posterior region was inferred to be essential for production of multiple oral movements, whether nonverbal or verbal, suggesting a critical role in the accurate selection of movements. Within the posterior region, there was further differentiation for multisyllabic speech into a parietal system, which appeared to mediate primarily praxic function, and a temporal system, which appeared to mediate verbal-echolalic function. Aphasias from anterior and posterior lesions resembled "Broca's" and "Wernicke's" aphasia only insofar as they differed in fluency, with anterior aphasics clearly less fluent. Tests of speech comprehension did not differentiate the groups. It is suggested that classifying aphasic patients via lesion location rather than aphasic typology might yield a view of functional subsystems different from those commonly accepted.