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the auditory cortex and posterior thalamus have been described; these and other biologic aspects of cerebral dominance have been reviewed by Geschwind and Galaburda and relate also to developmental dyslexia (Chap 28) Left-handedness may result from disease of the left cerebral hemisphere in early life; this probably accounts for its higher incidence among the mentally retarded and brain-injured Presumably the neural mechanisms for language then come to be represented in the right cerebral hemisphere Handedness and cerebral dominance may fail to develop in some individuals; this is particularly true in certain families In these individuals, defects in reading as well as stuttering, mirror writing, and general clumsiness are much more frequent and persistent during development In right-handed individuals, aphasia is almost invariably related to a left cerebral lesion; aphasia in such individuals as a result of purely right cerebral lesions ( crossed aphasia ) is very rare, occurring in only 1 percent of cases (Joanette et al) Cerebral dominance in ambidextrous and left-handed persons is not nearly so uniform In a large series of left-handed patients with aphasia, 60 percent had lesions con ned to the left cerebral hemisphere (Goodglass and Quadfasel) However, in the relatively rare case of aphasia due to a right cerebral lesion, the patient is nearly always left-handed; moreover, the language disorder in some such patients is less severe and enduring than in right-handed patients with comparable lesions in the left hemisphere (Gloning, Subirana) The latter ndings suggest a bilateral albeit unequal representation of language functions in non right-handed patients Using the Wada test, Milner and colleagues found evidence of bilateral speech representation in about 15 percent of 212 consecutively studied lefthanded patients There are undoubtedly language capacities of the nondominant hemisphere, but they have not been documented by careful anatomic studies As mentioned above, there is always some uncertainty as to whether residual function after lesions of the dominant hemisphere can be traced to recovery of parts of its language zones or to activity of the minor hemisphere The observations of Levine and Mohr suggest that the nondominant hemisphere has only a limited capacity to produce oral speech after extensive damage to the dominant hemisphere; their patient recovered the ability to sing, recite, curse, and utter one- or two-word phrases, all of which were abolished by a subsequent right hemisphere infarction The fact that varying amounts of language function may remain after dominant hemispherectomy in adults with glioma also suggests a de nite though limited capacity of the minor hemisphere for language production Kinsbourne s observations of the effect of amytal injections into the right-hemispheral arteries of patients who are aphasic from left-sided lesions make the same point However, congenital absence (or surgical section) of the corpus callosum, permitting the testing of each hemisphere, has shown virtually no language functions of the right hemisphere Some of these differences are attributable to variations in the clinical state of the subjects being tested and in the methods of language testing Despite its minimal contribution to the purely linguistic or propositional aspects of language, the right hemisphere does have a role in the implicit communication of feelings and emotion through expressed language It has long been known that when angered, globally aphasic patients can shout or curse These modulative aspects of language are subsumed under the term prosody, by which is meant the melody of speech its intonation, in ection, and pauses all of which have emotional overtones These prosodic components of speech and the gestures that accompany them.

Class 2 chart types include scatter charts, time scatter charts, histograms, and heatmaps They are not necessarily more complex than the class 1 chart types but are more specific to certain situations than the class 1 chart types Thus, in the case of class 2 chart types, we have a more defined set of data to use for building these charts In this case, you build the table on which a chart type of class 2 is based as follows: The first data row contains the values to be entered on the X axis The remaining data rows contain the Y values These data rows are converted into data series The number of data series in the chart is the total number of data rows minus 1 The X value of a data point is always from the first data row The Y value of a data point is from one of the remaining data rows, depending on the data series to which the data point belongs The data providers for histograms and heatmaps need a different structure; the requirements for these are described in the corresponding sections for these chart types

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enhance the meaning of the spoken word and endow language with its richness and vitality The related issue of the accent of speech, which carries such a strong regional identity, probably also has an anatomic meaning, but one that remains obscure (see later comments on the Foreign Accent Syndrome ) Many diseases and focal cerebral lesions mute the prosody of speech, the most dramatic examples being the hypophonic monotone of Parkinson disease and the effortful utterances of Broca s aphasia But in recent years, largely through the work of Ross, it has been shown that this de cit in prosody is also present in patients with strokes involving the territory of the right middle cerebral artery, ie, in portions of the nondominant hemisphere that mirror the language areas of the left hemisphere There is impairment both of comprehending and of producing the emotional content of speech and its accompanying gestures A prospective study of middle cerebral artery infarctions by Darby has corroborated this view; aprosodia was present only in those patients with lesions in the territory of the inferior division of the right middle cerebral artery The de cit was most prominent soon after the stroke and was not found with lacunar lesions We have had more dif culty in appreciating aprosodia as a result solely of right perisylvian lesions, and in most cases the damage has been more widespread There has been interest in a possible role for the cerebellum in language function, based partly on observations in the Williams syndrome, in which mental retardation is associated with a preservation of language skills that is sometimes striking in degree (Chap 38) In this disease, the cerebellum is spared in the face of greatly diminished volume of the cerebral hemispheres (see also Leiner et al) Some studies of cerebral blood ow also implicate the cerebellum in various language functions; but based on our clinical experience, we would judge any language de cits from cerebellar disease to be subtle or nonexistent.

pure motor disorder of the muscles of articulation and may be due to accid or spastic paralysis, rigidity, repetitive spasms (stuttering), or ataxia The terms dysarthria and anarthria are applied to this category of speech disorder 4 An alteration or loss of voice due to a disorder of the larynx or its innervation aphonia or dysphonia Articulation and language are unaffected The important category of developmental disorders of speech and language is considered fully in Chap 28