What is the Foreign Accent Syndrome?

The foreign accent syndrome ( SAE ) is a very rare alteration in which a person begins to show a foreign pronunciation or different from their native dialect without needing to have  had previous experience with the language from which they acquire the accent (Vares, 2015).

It is a rare disorder of the production of language in which the pronunciation of the patient is perceived as foreign by the listeners of their  community of speakers (Vares, 2015) due to an inability to produce the phonetic and phonological contrasts of the native dialect (Pyun et al.,  2013).

Foreign Accent Syndrome

Cases of foreign accent syndrome have been documented worldwide, including changes from Japanese to Korean accent, from British English to French,  from American English to British, and from Spanish to Hungarian (UTD, 2016).

Foreign Accent Syndrome

The foreign accent syndrome is a neurological disorder that in most cases occurs as a result of some type of injury or  brain damage. In addition, the existence of this pathology linked to development has also been observed.

Characteristics of the foreign accent syndrome

The foreign accent syndrome, also called pseudo-extraneous accent, is defined as a type of speech impairment acquired as a result  of the presence of some type of central nervous system lesion that will produce the appearance of a foreign accent when speaking the language native  (González-Alvarez, 2003).

The first case of this syndrome was described in 1917 by Marie and Foix, in which a patient from Paris acquired an accent from another region of  France (Alsace) after recovering from a lesion in the left hemisphere (Vares, 2015).

This phenomenon was described as “abnormal prosody” by Monrad-krohn who described the most well-known case of this pathology in the journal Brain (1974)  (González-Alvarez, 2003).

This much-talked-about house was about a woman of Norwegian origin who was hit by a Nazi shell in the Second World War, which caused her  severe head trauma. As a result of the brain injury began or show an obvious German accent (González-Alvarez, 2003).

Due to the temporary moment in which the presence of this alteration occurred, this caused important problems in his daily life to be  related to a Germanic origin (González-Alvarez, 2003).

In 2008, only scientific references of about 50 cases of foreign accent syndrome were found, increasing significantly the  reporting of this type of pathologies in recent years (Vares, 2015).

From the clinical description of the different cases it has been concluded that the modification of the accent arises from an alteration of the individual’s capacity to  program the sequencing and position of the movements that are essential for the production of language (Vares, 2015).

Abnormalities in accentuation, rhythm, intonation, articulation mode, consonant sound or articulation of  vowels and different alterations in the syllabic structure are presented (Vares, 2015).

Pinillos (2014) describes the most characteristic deficits that appear in patients with SAE according to the description proposed by  Buentello-García and collaborators:

1. Segmental alterations: greater alteration in the vowels than in consonants; modification of vowel pronunciation time (shorter or 
longer, modifications and errors in the pronunciation of consonants.

2. Prosodic alterations : variations of the thymus and intonation of the words and / or sentences; decrease of time between syllables, insertion of vowels,  scarce transition between word and word, inversion of tone of the phrases, among others.

Causes of  foreign accent syndrome

Normally, the causes of the foreign accent syndrome are associated with different neurological conditions (Pinillos, 2014).

Although the pathological and neurological substratum of this pathology are not clearly delimited, it usually occurs as a consequence of  cerebrovascular accidents, cranioencephalic disorders or other types of disorders, such as progressive primary aphasia (Pyun et al., 2013).

Generally, the etiological mechanisms will affect frontal areas of the left hemisphere, especially in the anterior region of the insula,  however there is still no agreement on this implication (Pyun et al., 2013).

Different current studies that use advanced neuroimaging techniques do not associate the appearance of SAE with focal lesions, but rather with several  cortical and / or subcortical lesions of small size that can be presented in a distributed manner (Pyun et al., 2013).


The majority of cases correspond to lesions in the left hemisphere (Pyun et al., 2013), however, their appearance will depend on the  location of the dominant hemisphere for language (Vares, 2015).

On the other hand, we must bear in mind that some cases of SAE have been described in the absence of cerebral accidents, linked to the development in particular to a  specific language disorder (Vares, 2015).

The presence or absence of a structural lesion does not predict the occurrence of this type of pathologies, since some techniques, such as PET, have described  a hypoperfusion of different regions without the presence of structural alterations associated with the foreign accent syndrome (Pyun et al., 2013),

Types of  foreign accent syndrome

Depending on the nature of this type of pathology, Jo Verhoeven and Peter Mariën (2010) have classified the main cases of SAE that have been published  in three categories (Vares, 2015):

– Neurogenic foreign accent syndrome : the pathology is a consequence of the changes that occur in the central nervous system  due to the presence of lesions usually in motor language areas. This category brings together both cases acquired and linked to development and  specific language disorders.

– Syndrome psychogenic alien accent : occurs as a result of some kind of exclusively psychological alteration,  without evidence of brain damage. In one of the cases described as psychogenic, the psychiatric examination showed a history associated with the treatment of  depression with suicidal tendencies.

– Mixed foreign accent syndrome : some authors point out the existence of a third type of pathology being the neurogenic etiological cause  but that after the psychological effect of this alteration entails psychogenic aspects, such as the emphasis of the new accent to  achieve greater conciliation and identity more coherent.

Treatments

Most cases that have been described of the Foreign Accent Syndrome have been examined from a research perspective, so the clinical area  has not been addressed in a meaningful way.

Little or almost nothing is known about the possible treatment of this singular pathological condition. Some authors like Duffy, in their descriptions  include the possibility of adapting different techniques used in aphasia or linguistic apraxias (Villaverde-Gonzalez, et al., 2003)

Resorting to a logopedic or neuropsychological intervention can be considered a good neurorehabilitation strategy. These interventions should be  aimed at modifying the rhythm of the speech, the distortions of the point and manner of articulation, the substitutions and variations in the production of  consonants or vowels, which contribute to the substantial variations of accent (Villaverde-Gonzalez, et al. , 2003)

In addition, the modification of prosody can have a crucial role in the origin of the accent. Prosodic improvement techniques, stress, rhythm and  naturalness, will be useful in reducing the foreign accent (Villaverde-Gonzalez, et al., 2003).

Also Read: What is Stereotyped Movement Disorder?

On the other hand, the Jaime I University and the Neurology Service of the Castellón Hospital (Spain), highlight the importance of auditory feedback  . Thus, some of the techniques used in the treatment of the dissemia have been shown to be effective in SAE. Some of these techniques are:

  • Masked Auditory Feedback (MAF).
  • Delayed auditory feedback (DAF, Delayed Auditory Feedback).
  • Auditory feedback with frequency change (FAF, Frequency-Shifted Auditory Feedback).

Some cases of SAE

  • Katz, Garst and Levitt (2008) describe the case of a 46-year-old woman whose native language was American English. He began to show an acceptance similar to that  of Sweden or Eastern European regions after suffering an allergic reaction that caused facial weakness, paralysis of the left side of the face  or slow speech. The neuroimaging studies showed that there was an alteration in the size of the lateral cerebral ventricles and a cortical atrophy  in the frontal lobe (Pinillos, 2014).
  • One of the last cases described in the scientific literature refers to a Spanish patient. This is a 51-year-old woman living in the  province of Castellón, whose pronunciation of Spanish began to show a foreign accent after suffering a stroke. This woman  used 4 different languages ​​(French, English, Valencian and Castilian) however, only the production of Spanish was affected (Vares, 2015)
  • On the other hand, the first case of SAE has recently been documented in which the affected person experiences different accents. This is a woman  native of Australia with 37 years of age, was admitted after giving a sudden difficulty to pronounce, weakness of the right side of the body,  problems of coordination, headache, among others. The neuroimaging studies revealed a cerebral hemorrhage. Several days later, he began to  show an involuntary and spontaneous accent that could be identified with French. Subsequently, in the following days, I came to experience at  least 6 different accents, some of which did not last more than 24 hours (Vares, 2015).

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