The 21st-century aphasiologist may be surprised to find a new book with such a title as Fluent Aphasia. Three decades of cognitive neuropsychology advances would seem sufficient to relegate a fuzzy concept like “fluent aphasia” as a relic of the past, or, at best, restrict it to the realm of shorthand descriptions meant to facilitate daily communication among clinicians. Even among those accustomed to strict collaboration, a concept like “fluent aphasia” may cause misunderstanding. I personally learned about aphasia directly from the Boston school. Yet, when I speak with my Italian colleagues from Milan, whom I have known for most of my professional life, and with whom I have written quite a few papers on aphasia, I am often unsure about what they mean when they label an aphasic patient as “fluent.” I still remember Harold Goodglass telling me, in almost the same words Susan Edwards quotes from him, how “fluency is best rated in terms of the longest occasional uninterrupted strings of words that are produced.” My own understanding of his teaching included the concept that the presence of phonetic problems and/or abnormal articulation effort was not so essential in drawing the fluency-non fluency distinction: according to his rule of thumb, fluent aphasia should be diagnosed when a patient can produce at least five connected words. This rule derived from observations made in Goodglass, Quadfasel, and Timberlake's (1964) study on phrase length and type of aphasia, whereby it was shown that aphasics can be dichotomized on the basis of the number of words that they can typically utter as an uninterrupted string. Edwards reports that other people entertain different beliefs about what is fluent aphasia. Surely several, heterogeneous criteria such as phrase length, verbal agility, melodic line, amount of articulation effort, and grammatical form are differently weighted by different aphasiologists as they consider their diagnosis.

This said, for what is a diagnosis of fluent aphasia ultimately meant? To this simple question I could not find an explicit answer anywhere in this book. In other words, we are never told exactly for what reason, beyond wanting to indicate with a general term all conditions resembling the classic categories of Wernicke, conduction, anomic and transcortical sensory aphasia (and not global, Broca's or transcortical motor), an aphasiologist should take some pain in setting more or less rigid criteria for isolating fluent aphasia as a concept. This is not exclusively Edwards's fault, since nowhere else can I find an answer to this question. Yet, numerous aphasiologists intuitively, it seems, find the concept useful. In my own experience, I always found Goodglass's rule helpful in telling me something about the lesion and the prognosis: if, no matter how bad the articulation is, an acute patient can produce, within a reasonably long conversation or piece of narrative, five grammatically connected words, then the bulk of the lesion is not likely to be in Broca's area but would be somehow more posterior. In the presence of articulation problems, I would regard this condition more likely to evolve in a positive way. But I cannot now easily locate these notions in Goodglass's writings, and they may not have come from him but from my doubtable memory. This is just an example of how, based more upon intuition and oral transmission rather than upon secure empirical and theoretical grounds, the notion of fluent aphasia may serve, rather idiosyncratically, different purposes for individual aphasiologists. Then why, with this degree of variability and arbitrariness, should one care about “fluent aphasia” at all?

Susan Edwards takes a theoretically oriented clinician's approach, and in so doing, manages to convince the reader that, indeed, the notion of fluent aphasia is currently useful and may have a future. I think she succeeds in her intent insofar she shows how much there is to be gained in studying aphasics' connected speech. She starts, in fact, with the provoking statement that “fluent aphasia is … commonly seen in clinics but (about it) … little is written (p. 1).” One understands to what extent she is right as soon as she makes clear that she considers drawing on connected speech data the pivotal means of obtaining new and important information on aphasia. The best part of the book is indeed that portion devoted to connected speech, and it may be true that studies of connected speech are much less numerous for fluent aphasia categories compared to those available for non-fluent categories.

In the first chapter she tries to identify fluent aphasia as a self-standing concept from Wernicke's time onward. Due consideration, here as well as very often throughout the whole book, is paid to the work of Goodglass and of the Boston school. Notably, however, no mention is made of the work of Norman Geschwind, of his revival of the old aphasiology masters, and of the anatomically based interpretative framework that so heavily influenced thinking at the Boston V.A. Aphasia Research Center and elsewhere. Indeed, according to Goodglass (1993, p. 33), it is Geschwind who deserves credit for introducing the terms “fluent” and “non-fluent” to designate the two major subtypes of aphasic syndromes. Nevertheless Geschwind is mentioned, en passant, only later in Chapter 3, whereby his contribution to the concept of fluent aphasia is briefly acknowledged, and, oddly, Goodglass is said to have been his student (sic). Other 20th-century descriptions of fluent aphasia are reported, overwhelmingly within the Anglo-Saxon tradition, whereas important contributions from the Russian, the French, the German, and the Italian schools do not receive much mention. This is the author's choice and a comprehensive review of available literature on fluent aphasia is clearly not within the scope of this book. Issues including the utility of syndromes, the syndrome-lesion site relationship and converging evidence brought about by studies with normal subjects complete the chapter.

The second chapter describes fluent aphasia in the context of the most popular psycholinguistic models, whereby the origin of the most distinctive errors made by fluent aphasics is located. A description of such errors is provided with examples and with a long discussion of how lexical problems may interfere with grammatical problems in producing the characteristic pattern of fluent aphasic speech. Chapter 3 is devoted to assessment and contains a critical description of most commonly used aphasia batteries. It also contains an updated description of several diagnostic instruments recently developed for assessing aphasia within theoretically driven research projects. A final note warns the reader about several limitations of aphasia assessments as clinical and as research tools.

The book enters its most interesting and original part with Chapter 4. Anybody wanting to study connected speech in aphasia could profitably start by reading this chapter. Ways of collecting representative samples, their strengths and weaknesses, and problems in qualitative as well as quantitative analysis of data are thoroughly reported. As Edwards notes, different perspectives yield different interpretations. Examples are provided of how recently developed, sophisticated coding schemes can capture interesting, revealing details about disorders of sentence structure when applied to fluent aphasic production. In Chapter 5, Edwards leads the reader to consider current debates over the nature of production and comprehension problems in agrammatism. In doing so she manages to render palatable and balanced descriptions of theoretical stances that have been furiously challenged in recent years. While agrammatism is most often, but not necessarily, associated with non-fluent aphasia, this discussion is justified in the context of this book since findings in fluent aphasia have been frequently used as a meaningful contrast.

Comprehension problems in fluent aphasia, remarkably more severe and frequent (but how different in quality?) than in non-fluent, non-global varieties, are described in Chapter 6. Clinical phenomena are reported along with their interpretation since Wernicke's time. The contribution of non-linguistic factors to comprehension deficits is also discussed. Comprehension at the single word level and comprehension of sentences has been found to be influenced by various factors like argument structure and movement that are generally ignored in clinical reports, but, Edwards shows, have increasingly captured researchers' attention for the last two decades. Chapter 7 reports a single paradigmatic case of fluent aphasia, underlining the fact that no linguistic dimension may be considered unimpaired. Concluding remarks and some interesting afterthought constitute the bulk of the last chapter.

This book may be in many ways a useful one. It is not omni-comprehensive, in that it does not review, as the potential customer may be led into believing, all issues concerned with fluent aphasia. For example, it ignores, as mentioned earlier, very significant contributions from non-Anglo-Saxon literature. Also, while phonological disturbances are described, the account of research on segmental and supra-segmental phonology in fluent aphasia is kept to a minimum with respect to the generous spaces allotted to lexical and grammatical aspects. This is to some extent surprising, since phonological disturbances may interact in non obvious ways with the production of fluent aphasic speech. Moreover, the study of phonologically related phenomena like, for example, hesitations has been used to draw inferences on the nature of lexical and grammatical disorders in fluent aphasia. However, this book comes forth with a very strong message: studies of connected speech will make the future of aphasiology. Edwards lays down for the reader, in a relatively simple way, the theoretical ground for further, effective, studies of lexical and grammatical aspects of connected speech in fluent aphasia. And, in dealing with both the productive as well as the receptive side, she provides abundant indications of ways to exploit the outcome of such investigations in an interesting way.

A few remarks on readability and ideal readership must be added as a conclusion. The vivid and occasionally colloquial style does not in itself make this book easy to read. The intent to discuss clinical phenomena and theoretical and research issues on the same time accounts for some difficulty in keeping the thread of several arguments. For this reason I would hesitate in recommending this book to beginners, maybe with an exception for one or two chapters (notably Chapter 3). I recommend it to any expert neuropsychologist wanting to start exploring connected speech in aphasia and to linguists and psycholinguists curious about where aphasiology is nowadays on several issues within their respective interests. They should, however, be aware that there is much more recent and interesting material about aphasia than they can learn from this book. Finally, the expert 21st-century aphasiologist will find in Edwards's book plenty of hidden and less hidden inspirational tips for very interesting research. Reviving the concept of fluent aphasia may not have been, indeed, a waste of time.