Lecturer's Précis - Wepman, Jones, Bock, and Van Pelt (1960)

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First published online 15:52 BST 28th August 2002, Copyright Derek J. Smith (Chartered Engineer). This version [HT.1 - transfer of copyright] dated 12:00 13th January 2010

 

Wepman et al's (1960) Clinical Cognitive Hierarchy Diagram

Joseph M. Wepman, Director of the Speech and Language Clinic at the University of Chicago during the 1960s, was conscious of the often striking individual differences in speech and language patients with superficially identical lesions, and recommended using models of human cognitive architecture to assist their assessment and treatment. Without the analytical power of these models, he argued, there was a lack of useful diagnostic data, and a serious "lack of objectivity" to the managementprocess. The aphasias, in short, were a poorly conceptualised area, relying almost totally on the individual experience of the clinician. [In modern medical parlance, management programmes were neither "evidence-based" nor "protocol-driven".] In 1959, Wepman presented his ideas at the 11th Congress of the International Association of Logopedics and Phoniatrics in London, and in 1960 formally published that presentation in the paper here reviewed.

The paper begins by revisiting the already 80-year old argument between the globalists and the localisationists [if unfamiliar with this debate, then read the entries for diagram makers and Globalist School in our glossary, and look up the authors mentioned in our neuropsychology timeline]. It then notes how "modality-bound, nonsymbolic problems" often occur in the clinic, but cannot be explained by the sort of "symbolic formulation problems" presumed by the classical explanations. If, for example, one tested patients' powers to imitate, then this ability was found to vary independently of those same patients' powers to conceptualise. It was accordingly important to take "lower level function" (p326) into account, and to distinguish between the transmission and processing aspects of the nervous system.

The result was a model with three substages to both the vertical and the horizontal aspects. The three vertical divisions represent levels of the motor hierarchy, from reflex at the bottom to fully conscious at the top, and the three horizontal divisions represent stages of processing - input on the left, integration in the middle, and output on the right - within any one level. This makes nine processing sectors in all, as shown in the following diagram:

Wepman et al's (1960) Clinical Cognitive Hierarchy: This is a nice example of a three-layer A-shaped diagram, complete with within-level reflex pathways at both the lower levels. Note the three horizontal stages of processing - inward transmission, integration, and outward transmission - and the three levels of processing, higher, intermediate, and reflex. What makes the diagram particularly useful to students is its inclusion of clinical diagnostics (red, uppercase). These captions are positioned to indicate the nature of the externally observable speech or language deficit which would be associated with a lesion at the point shown. If we compare this layout with Lichtheim's (1885) "house" model (one of the classical school), Wepman's three successive input modules (yellow) correspond to Lichtheim's "A" module, the three successive output modules (green) correspond to Lichtheim's "M" module, and the uppermost integration module (tan) corresponds to Lichtheim's "B" module.

PICwepmanetal1960.gif

Developed from a black and white original in Wepman et al (1960), with colour highlighting added for effect. Everything not in blue is from the original paper. The blue lettering shows enhancements by Perkins (1977). The final version Copyright © 2002, Derek J. Smith.

 

References

Perkins, W.H. (1977). Speech Pathology: An Applied Behavioural Science. St. Louis, MO: Mosby.

Wepman, J.M., Jones, L.V., Bock, R.D., & Van Pelt, D. (1960). Studies in aphasia: Background and theoretical formulations. Journal of Speech and Hearing Disorders, 25:323-332.