Effects of right- and left-hemisphere damage on understanding conversational implicatures

Theory of mind in utterance interpretation: the case from clinical pragmatics

The cognitive basis of utterance interpretation is an area that continues to provoke intense theoretical debate among pragmatists. That utterance interpretation involves some type of mind-reading or theory of mind (ToM) is indisputable. However, theorists are divided on the exact nature of this ToM-based mechanism. In this paper, it is argued that the only type of ToM-based mechanism that can adequately represent the cognitive basis of utterance interpretation is one which reflects the rational, intentional, holistic character of interpretation. Such a ToM-based mechanism is supported on conceptual and empirical grounds. Empirical support for this view derives from the study of children and adults with pragmatic disorders. Specifically, three types of clinical case are considered. In the first case, evidence is advanced which indicates that individuals with pragmatic disorders exhibit deficits in reasoning and the use of inferences. These deficits compromise the ability of children and adults with pragmatic disorders to comply with the rational dimension of utterance interpretation. In the second case, evidence is presented which suggests that subjects with pragmatic disorders struggle with the intentional dimension of utterance interpretation. This dimension extends beyond the recognition of communicative intentions to include the attribution of a range of cognitive and affective mental states that play a role in utterance interpretation. In the third case, evidence is presented that children and adults with pragmatic disorders struggle with the holistic character of utterance interpretation. This serves to distort the contexts in which utterances are processed for their implicated meanings. The paper concludes with some thoughts about the role of theorizing in relation to utterance interpretation.

Comportamento comunicativo de indivíduos com diagnóstico de esquizofrenia

Objetivo descrever o comportamento comunicativo de indivíduos com diagnóstico de esquizofrenia em processo de reabilitação psicossocial. Métodos estudo descritivo-exploratório, com amostra por conveniência de recorte transversal. Participaram 50 indivíduos com diagnóstico de esquizofrenia, de ambos os sexos, com faixa etária entre 19 e 75 anos, usuários de um Núcleo de Saúde Mental de uma cidade do interior do estado de São Paulo, Brasil. Foi realizado levantamento nos prontuários para obter dados pessoais e o subtipo da esquizofrenia. Para avaliar o comportamento comunicativo utilizou-se a Bateria Montreal de Avaliação da Comunicação (Bateria MAC), constituída por 14 tarefas que avaliam os aspectos discursivo, pragmático inferencial, léxico-semântico e prosódico da linguagem. Resultados os indivíduos, em sua maioria, eram do sexo masculino, com baixa escolaridade, praticantes do catolicismo e com esquizofrenia do subtipo paranoide. A avaliação pela Bateria MAC apontou alterações em todas as tarefas avaliadas e a maioria dos participantes respondeu que é consciente da dificuldade comunicativa. As maiores alterações ocorreram nas tarefas de evocação lexical com critério semântico, atos de fala indiretos, discurso conversacional e discurso narrativo, e, as menores alterações, ocorreram nos componentes prosódicos no nível de compreensão, destacando-se que, o nível da produção nos aspectos linguísticos e emocionais da prosódia, também apresentou alteração considerável. Conclusão todas as tarefas avaliadas apresentaram alterações. Os aspectos mais prejudicados foram o discurso e a pragmática, que não devem ser relacionados somente aos aspectos linguísticos, mas também às características de alteração do pensamento e da cognição, ao embotamento afetivo e questões sociais desse transtorno.

Social cognition of indirect speech: Evidence from Parkinson's Disease

We examined potential neurocognitive mechanisms of indirect speech in support of face management in 28 patients with Parkinson's disease (PD) and 32 elderly controls with chronic disease. In experiment 1, we demonstrated automatic activation of indirect meanings of particularized implicatures in controls but not in PD patients. Failure to automatically engage comprehension of indirect meanings of indirect speech acts in PD patients was correlated with a measure of prefrontal dysfunction. In experiment 2, we showed that while PD patients and controls offered similar interpretations of indirect speech acts, PD participants were overly confident in their interpretations and unaware of errors of interpretation. Efficient reputational adjustment mechanisms apparently require intact striatal-prefrontal networks.

Aphasia therapy on a neuroscience basis

BACKGROUND: Brain research has documented that the cortical mechanisms for language and action are tightly interwoven and, concurrently, new approaches to language therapy in neurological patients are being developed that implement language training in the context of relevant linguistic and non-linguistic actions, therefore taking advantage of the mutual connections of language and action systems in the brain. A further well-known neuroscience principle is that learning at the neuronal level is driven by correlation; consequently, new approaches to language therapy emphasise massed practice in a short time, thus maximising therapy quantity and frequency and, therefore, correlation at the behavioural and neuronal levels. Learned non-use of unsuccessful actions plays a major role in the chronification of neurological deficits, and behavioural approaches to therapy have therefore employed shaping and other learning techniques to counteract such non-use. AIMS: Advances in theoretical and experimental neuroscience have important implications for clinical practice. We exemplify this in the domain of aphasia rehabilitation. MAIN CONTRIBUTION: Whereas classical wisdom had been that aphasia cannot be significantly improved at a chronic stage, we here review evidence that one type of intensive language-action therapy (ILAT)-constraint-induced aphasia therapy-led to significant improvement of language performance in patients with chronic aphasia. We discuss perspectives for further improving speech-language therapy, including drug treatment that may be particularly fruitful when applied in conjunction with behavioural treatment. In a final section we highlight intensive and rapid therapy studies in chronic aphasia as a unique tool for exploring the cortical reorganisation of language. CONCLUSIONS: We conclude that intensive language action therapy is an efficient tool for improving language functions even at chronic stages of aphasia. Therapy studies using this technique can open new perspectives for research into the plasticity of human language circuits.

Metanálise de estudos do processamento comunicativo em indivíduos com lesão vascular direita

Esta pesquisa apresenta estudos com indivíduos com lesão vascular no hemisfério direito, investigando-se o desempenho dessa população nos processamentos comunicativos discursivo, pragmático-inferencial, léxico-semântico e prosódico. A literatura de neuropsicologia atual tem enfocado cada vez mais as relações entre linguagem, comunicação, cognição e emoção através do estudo das funções do hemisfério direito em indivíduos com e sem lesão. Foram analisados os aspectos metodológicos e os resultados de 25 estudos das fontes Medline e Science Direct. Evidenciou-se que dos 357 lesados de hemisfério direito participantes, 330 (92,4%) apresentaram alterações quantitativas e/ou qualitativas nas habilidades comunicativas avaliadas. O hemisfério direito parece desempenhar um papel importante no processamento das habilidades comunicativas discursivas, pragmático-inferenciais, léxico-semânticas e prosódicas.

Right hemisphere damage: Communication processing in adults evaluated by the Brazilian Protocole MEC - Bateria MAC

Right-brain-damaged individuals may present discursive, pragmatic, lexical-semantic and/or prosodic disorders.

OBJECTIVE

To verify the effect of right hemisphere damage on communication processing evaluated by the Brazilian version of the Protocole Montréal d'Évaluation de la Communication (Montreal Communication Evaluation Battery) - Bateria Montreal de Avaliação da Comunicação, Bateria MAC, in Portuguese.

METHODS

A clinical group of 29 right-brain-damaged participants and a control group of 58 non-brain-damaged adults formed the sample. A questionnaire on sociocultural and health aspects, together with the Brazilian MAC Battery was administered.

RESULTS

Significant differences between the clinical and control groups were observed in the following MAC Battery tasks: conversational discourse, unconstrained, semantic and orthographic verbal fluency, linguistic prosody repetition, emotional prosody comprehension, repetition and production. Moreover, the clinical group was less homogeneous than the control group.

CONCLUSIONS

A right-brain-damage effect was identified directly, on three communication processes: discursive, lexical-semantic and prosodic processes, and indirectly, on pragmatic process.

Metaphor explanation attenuates the right-hand preference for depictive co-speech gestures that imitate actions

Differential activation levels of the two hemispheres due to hemispheric specialization for various linguistic processes might determine hand choice for co-speech gestures. To test this hypothesis, we compared hand choices for gesturing in 20 healthy right-handed participants during explanation of metaphorical vs. non-metaphorical meanings, on the assumption that metaphor explanation enhances the right hemisphere contribution to speech production. Hand choices were analyzed separately for: depictive gestures that imitate action ("character viewpoint gestures," [McNeill, D. (1992). Hand and mind. What gestures reveal about thought. Chicago: University of Chicago Press.]), depictive gestures that express motion, relative locations, and shape ("observer viewpoint gestures"), and "abstract deictic gestures." It was found that the right-hand over left-hand preference was significantly weaker in the metaphor condition than in the non-metaphor conditions for depictive gestures that imitated action. Findings suggest that the activation of the right hemisphere in the metaphor condition reduces the likelihood of left hemisphere generation of gestures that imitate action, thus attenuating the right-hand preference.

Social communication impairments: pragmatics

Social communication or pragmatic impairments are characterized and illustrated as involving inappropriate or ineffective use of language and gesture in social contexts. Three clinical vignettes illustrate different pragmatic impairments and the wealth of diagnostic information that can be garnered from observation of a child's social communication behavior. Definitions of, and developmental milestones in, domains of pragmatic competence are provided. Several screening instruments are suggested for use in assessing pragmatic competence within the time-frame of a pediatric examination. Frequent comorbid psychiatric conditions are described and a sample of current neurobiologic research is briefly summarized.

Alterações cognitivas, comunicativas e emocionais após lesão hemisférica direita: em busca de uma caracterização da Síndrome do Hemisfério Direito

O conjunto de sinais e sintomas observados após um acometimento neurológico no hemisfério direito pode ser denominado de Síndrome do Hemisfério Direito &– SHD. Esse ensaio teórico tem por objetivo apresentar uma caracterização desse quadro neuropsicológico. A SHD é, então, caracterizada por déficits nas funções cognitivas atenção, percepção, memória, praxias e funções executivas, com a presença de anosognosia, heminegligência sensorial, prosopagnosia, alterações de memória visuo-espacial e de trabalho, dispraxia construtiva e disfunção executiva. Quanto às habilidades comunicativas, a SHD engloba alterações nos componentes discursivo, pragmático-inferencial, léxico-semântico e prosódico. Os déficits de processamento emocional incluem dificuldades de compreensão e produção de emoções a partir de expressões faciais ou emissões vocais e alterações neuropsiquiátricas. Há, no entanto, uma heterogeneidade na sua manifestação. Tendo em vista essa variabilidade de sinais e sintomas, mais estudos de caso e de grupo com indivíduos lesados de hemisfério direito devem ser conduzidos para um melhor entendimento da SHD.

Broad-Perspective Perceptual Disorder of the Right Hemisphere

Traditional accounts of right-posterior brain injury describe a syndrome of low-level perceptual sequelae producing marked acute dependency and transient safety concerns. The syndrome is also held to spare cognition and to carry a generally favorable long-term prognosis. The present paper reviews publications and anecdotal data that challenge this picture. Recent theoretical expositions and empirical studies stipulate three major cognitive functions of the right posterior association cortex: processing novel input, guiding reactions to emergencies, and anticipating consequences. Appearing benign after acute recovery, the impairment of these processes produces vocational, social and marital dysfunctions that increase as a function of chronicity, ultimately becoming more broadly disabling than focal injuries in other cortical loci. The unique symptom picture and serious implications suggest that the long-term syndrome should be labeled (Broad-Perspective Perceptual Disorder) and incorporated in future clinical taxonomies, underscoring the need for extraordinary long-term assistance and specialized therapeutics. Procedures for assessment and differential diagnosis are outlined.

Normative data on the Korean version of the Western Aphasia Battery

The study aimed to describe the properties of the Korean version of the Western Aphasia Battery (hereinafter K-WAB) and to present the normative data of normal individuals and patients. The K-WAB contains the same test contents and structure as the original WAB and the general test administration method was maintained. We administered the K-WAB to 224 normal adults in seven age groups (1524, 2534, 3544, 4554, 5564, 6574, and 75 years or older), in five educational levels (0, 16, 79, 1012, and 13 years or more) and by gender. The age and educational levels were influential to the K-WAB performance. Accordingly, we formed six subgroups of the normal: two age groups (1574, and 75 years or older groups) by three educational groups (0, 16, and 7 years or more). Two hundred thirty-eight patients were also evaluated using the K-WAB. The highest aphasia quotient (AQ), language quotient (LQ), and cortical quotient (CQ) were achieved by 1574 age group with 7 or more years of education (M=97.11,M=95.51,M=95.57, respectively). Based on the receiver operating curve (ROC) analyses on AQ, LQ and CQ values, cut-off scores to optimally differentiate between the normal and the aphasic individuals were also provided.

Comprehension of indirect requests by persons with fluent aphasia

This study examined the judgments and response latencies of 10 participants with aphasia and 10 participants without aphasia for responses to indirect requests. Modals such as can and should were drawn from 5 indirect request categories. There was a significant difference in judgment errors and response latency between participants with and without aphasia. There were no significant differences between aphasic participants' judgments for literal versus nonliteral contrasts. There was a significant effect among the modals and among the categories of indirect requests. Response latency reflected aphasic participants' understanding of these indirect requests.

Effects of right and left hemisphere damage on performance of the "Right Hemisphere Communication Battery"

A Hebrew adaptation of Gardner and Brownell's (1986) "Right Hemisphere Communication Battery" (HRHCB) was administered to 27 right brain-damaged (RBD) patients, 31 left brain-damaged (LBD) patients, and 21 age-matched normal controls. Both patient groups showed deficits relative to controls and overall there was no difference between the two patient groups. A factor analysis of patients' scores on the HRHCB yielded two interpretable factors, a verbal and a nonverbal one. These factors were not lateralized. Performance of patients on the HRHCB correlated significantly and positively with performance on most tests of basic language functions, measured with a Hebrew adaptation of the "Western Aphasia Battery" (HWAB) and with other cognitive functions measured with standardized neuropsychological tests. There were stronger correlations of HRHCB with subtests of the HWAB in LBD patients and with nonlanguage cognitive tests in RBD patients. In the LBD group, HRHCB subtests' scores correlated negatively with lesion extent in frontal and temporal perisylvian regions. Such localization was not observed in RBD patients. The results argue against selective right hemisphere (RH) involvement in the RHCB, alleged to measure pragmatic aspects of language use, and show, instead, bilateral involvement. The results also argue against a modular organization of these functions of language use, especially in the RH.

Clinical note: acquired pragmatic impairments and aphasia

Recent advances in the field of communication sciences have led to the description of acquired communication disorders affecting pragmatic skills in patients with brain damage. The present article discusses the impact of such findings on the clinical concept of aphasia. Through reference to a number of articles contained in this Special Issue, it must be reiterated that pragmatic and other linguistic components of communication abilites are two sides of a same coin-that of language-and intimately interrelated. It is also argued that the difference between traditional (e.g., syntax) and pragmatic components of language cannot be explained in simple terms such as the former being subserved only by linguistic processes and the latter by other cognitive processes. Pragmatic components are thus to be considered as part of language. The evolution of the concept of language has a direct impact on the clinical concept of aphasia. Indeed, if aphasia corresponds to an acquired impairment of language, then pragmatic impairments must be considered part of aphasia. The inclusion of pragmatic impairments in the concept of aphasia does not hold only when they occur within the frame of classic types of aphasia, but also when they occur in isolation. Consequently, a new type of aphasia-pragmatic aphasia-should be considered and defined in order to describe the clinical condition of those individuals suffering from acquired pragmatic disorders as those reported among right-hemisphere-damaged right-handers. It is concluded that the recent evolution around the concept of language should be followed by an evolution of the concept of aphasia per se.