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 [2.1 - link to graphic] dated 09:00 3rd July 2018
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:
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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. If this diagram fails to load
automatically, it may be accessed separately at |
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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.