The role played by the right hemisphere in the organization of complex textual structures

Pragmatic Communication Deficit and Functional Outcome in Patients with Right- and Left-Brain Damage: A Pilot Study

Pragmatic communication abilities refer to the capacity to use language in a social context. Despite evidence to the contrary, the left cerebral hemisphere of the majority of right handers has been considered exclusively specialized for control of language phonology, syntax and semantics, whereas the right hemisphere has been specialized for the control of language pragmatics. Many studies have shown the non-exclusivity of the left hemisphere for language skills. Communication deficits observed in these studies for patients with right hemisphere damage confirmed the necessity for integrity of the right hemisphere across a number of language components. The aim of this study is to investigate the specific role of the right and left hemispheres across several aspects of communication deficits, with particular attention given to the influence of these deficits on functional outcome. The second aim is to characterize possible correlations between pragmatic and other cognitive deficits. We evaluated 22 patients, 15 with left- and 7 with right-brain ischemic or hemorrhagic damage, using cognitive, pragmatic and language tests. We deployed the Right Hemisphere Language Battery-Santa Lucia and Montreal d'Evaluation de la Communication to assess pragmatic abilities. The results showed no statistically significant differences between patients with left- and right-brain damage, highlighting the importance of integration between the two hemispheres in the communication process. Multiple significant correlations were found between pragmatic abilities and cognitive tests assessing global cognitive functioning, pantomime expression and comprehension. Pragmatic deficits were also shown to correlate with functional cognitive outcome. It is important to assess pragmatic abilities in patients with cognitive deficits after both left and right stroke for tailoring neuropsychological intervention to mitigate pragmatic disabilities in functional outcomes.

Affective Prosody and Its Impact on the Neurology of Language, Depression, Memory and Emotions

Based on the seminal publications of Paul Broca and Carl Wernicke who established that aphasic syndromes (disorders of the verbal-linguistic aspects of communication) were predominantly the result of focal left-hemisphere lesions, "language" is traditionally viewed as a lateralized function of the left hemisphere. This, in turn, has diminished and delayed the acceptance that the right hemisphere also has a vital role in language, specifically in modulating affective prosody, which is essential for communication competency and psychosocial well-being. Focal lesions of the right hemisphere may result in disorders of affective prosody (aprosodic syndromes) that are functionally and anatomically analogous to the aphasic syndromes that occur following focal left-hemisphere lesions. This paper will review the deductive research published over the last four decades that has elucidated the neurology of affective prosody which, in turn, has led to a more complete and nuanced understanding of the neurology of language, depression, emotions and memory. In addition, the paper will also present the serendipitous clinical observations (inductive research) and fortuitous inter-disciplinary collaborations that were crucial in guiding and developing the deductive research processes that culminated in the concept that primary emotions and related display behaviors are a lateralized function of the right hemisphere and social emotions, and related display behaviors are a lateralized function of the left hemisphere.

A common neural code for meaning in discourse production and comprehension

How does the brain code the meanings conveyed by language? Neuroimaging studies have investigated this by linking neural activity patterns during discourse comprehension to semantic models of language content. Here, we applied this approach to the production of discourse for the first time. Participants underwent fMRI while producing and listening to discourse on a range of topics. We used a distributional semantic model to quantify the similarity between different speech passages and identified where similarity in neural activity was predicted by semantic similarity. When people produced discourse, speech on similar topics elicited similar activation patterns in a widely distributed and bilateral brain network. This network was overlapping with, but more extensive than, the regions that showed similarity effects during comprehension. Critically, cross-task neural similarities between comprehension and production were also predicted by similarities in semantic content. This result suggests that discourse semantics engages a common neural code that is shared between comprehension and production. Effects of semantic similarity were bilateral in all three RSA analyses, even while univariate activation contrasts in the same data indicated left-lateralised BOLD responses. This indicates that right-hemisphere regions encode semantic properties even when they are not activated above baseline. We suggest that right-hemisphere regions play a supporting role in processing the meaning of discourse during both comprehension and production.

Narrative discourse production in Parkinson's disease: Decoupling the role of cognitive-linguistic and motor speech changes

Introduction

the interplay between neuropsychological and communicative abilities in Parkinson's disease (PD) has been relatively overlooked, and it is not entirely understood which difficulties are consequent to impaired motor control, and which have a linguistic/cognitive basis. Here, we examined narrative discourse in PD using a multi-level analysis procedure considering sentence-level (productivity, lexical-grammatical processing) and discourse-level processes (narrative organization, informativeness), and partialling out patients' motor speech impairments. The interaction between cognitive (i.e. linguistic and executive) and communication abilities was also investigated.

Methods

Twenty-nine PD subjects in the mild stage of the disease were compared to 29 matched healthy comparators (HC) on quantitative measures of narrative discourse derived from two picture description tasks. Multivariate (considering articulation rate and educational attainment as covariates) and univariate (with group membership as independent variable) analyses of variance were conducted on separate linguistic domains. The contribution of executive/linguistic abilities to PD's narrative performance was explored by multiple regression analyses on narrative measures significantly differentiating patients from HC.

Results

significant reductions in patients were observed on measures of productivity (less well-formed words, shorter sentences) and informativeness (fewer conceptual units, less informative elements, lower number of details) and these alterations were explained by variations in linguistic abilities (action and object naming) rather than executive abilities. Articulation rate and educational attainment did not impact the observed reduced productivity and under-informativeness.

Conclusion

referential narrative discourse is altered in PD, regardless of motor impairments in speech production. The observed reductions in productivity/informativeness aspects of narratives were related to naming abilities and in particular to verbs processing, consistently with the neurocognitive model of motor language coupling. Since narratives are amenable to recurrent and automated analysis for the identification of linguistic patterns potentially anticipating the development of PD and the onset of cognitive deterioration, discourse abilities should be quantitatively and repeatedly profiled in the disorder.

Pragmatic deficits in patients with schizophrenia and right hemisphere damage: A pilot study

BACKGROUND

While pragmatic deficits are well documented in patients with schizophrenia (SCZ) and right hemisphere damage (RHD), there is a paucity of research comparing the pragmatic deficits of these two groups. Do they experience similar cognitive dysfunction or is there a dissociation between the two patient groups?

AIMS

To investigate the nature of pragmatic deficits in these two groups and to gain an understanding of the underlying cognitive mechanisms that might be associated with these deficits to further future investigations.

METHODS & PROCEDURES

A total of 60 participants (15 patients with SCZ; 15 with RHD; 30 (15 + 15) healthy controls (HC) were administered the Bengali Audio-Visual Test-Battery for Assessment of Pragmatic Skills.

OUTCOMES & RESULTS

Both SCZ and RHD patients were found to have significant pragmatic deficits compared with their matched controls. SCZ patients were found to score significantly better than the RHD group in six out of the 10 pragmatic skills when controlled for age and education. Discriminant function analysis was performed and 86.7% of the cases (HC = 100%, SCZ = 73.3% and RHD = 86.7%) were correctly reclassified into their original categories using the test scores.

CONCLUSIONS & IMPLICATIONS

The study suggests that there is heterogeneity in the nature of the pragmatic breakdown within and across patient groups. Therefore, individualized restorative measures targeting the disrupted cognitive mechanism(s) might help elevate pragmatic competence and enhance the social functioning of patients with pragmatic deficits.

WHAT THIS PAPER ADDS

What is already known on the subject Pragmatic deficits are common in adults with cognitive impairments of different etiologies. However, few studies have explored pragmatic deficits across clinical populations. Consequently, very little is known about the nature of pragmatic deficits in patients with schizophrenia and right hemisphere damage. What this paper adds to existing knowledge This work offers preliminary data on pragmatic difficulties in patients with schizophrenia and right hemisphere damage. This study overrides the boundaries of traditional classifications and evaluates pragmatic difficulties in these two clinical populations with reference to the underlying cognitive mechanisms, which might be disrupted. What are the potential or actual clinical implications of this work? The study adds a transdiagnostic perspective suggesting that there might be heterogeneity in pragmatic deficits, both within and across patient groups, and stresses the need for individualized therapy.

Individual differences among older adults with mild and moderate dementia in social and emotional loneliness and their associations with cognitive and psychological functioning

Background

Loneliness is a major health issue among older adults. The aim of this study was to assess the relationship between loneliness, in its social and emotional facets, and the cognitive (language), and behavioral/psychological functioning as well as quality of life (QoL) in people with mild and moderate dementia, i.e., considering dementia severity as an individual characteristic.

Methods

This cross-sectional study involved 58 people with mild dementia and 55 people with moderate dementia. Participants completed the Social and Emotional Loneliness scale, along with measures assessing their language skills, the frequency and severity of their behavioral and psychological symptoms, and their QoL.

Results

Socio-demographic characteristics and depression, but not loneliness or its social and emotional facets, contributed to explain participants’ behavioral and psychological symptoms, regardless of dementia severity. Loneliness explained, though to a small extent (8% of variance), language skills in people with moderate dementia, with social loneliness only accounting for language skills (18% of variance) in this group. Loneliness also modestly accounted for dysphoria symptoms in both the mildly and moderately impaired (6% and 5% of variance, respectively) individuals with social loneliness predicting dysphoric mood in the former group only (7% of variance). Loneliness also explained, to a larger extent, QoL in both the mildly impaired and moderately impaired individuals (27% and 20% of variance, respectively), its social facet predicting QoL in the mildly impaired (30% of variance), and its emotional facet in the moderately impaired (21% of variance) group.

Conclusion

These findings suggest that loneliness and its facets have a clear impact on perceived QoL, and influence the language skills and dysphoria symptoms of people with dementia, to a degree that depends on dementia severity. The assessment of loneliness and its facets in people with dementia considering dementia severity, and the promotion of social inclusion to reduce it should be considered by professionals.

An Analysis of Right Hemisphere Stroke Discourse in the Modern Cookie Theft Picture

PURPOSE

Adults with right hemisphere damage demonstrate differences in connected speech compared to controls, but systematic, quantitative methods to capture these differences are lacking. The current study aimed to (a) investigate if measures using the Modern Cookie Theft picture description would identify discourse differences in acute right hemisphere stroke, and (b) examine if discourse differences were associated with documented cognitive impairment.

METHOD

Eighty-four participants completed the Modern Cookie Theft picture description within 5 days of right hemisphere stroke. Descriptions were analyzed for multiple microlinguistic characteristics. Medical charts were retrospectively reviewed for documented presence of cognitive impairment.

RESULTS

Individuals with acute right hemisphere stroke produced fewer content units, total syllables, and lower left-right content unit ratios compared to controls, indicating a paucity of informativeness. Presence of cognitive impairment was associated with fewer content units produced.

CONCLUSIONS

Multiple measures of microlinguistic discourse characteristics differentiated adults with right hemisphere stroke from controls, highlighting variations in both the quantity and quality of connected speech. Findings continue to underscore the contribution and correlation between cognitive skills and discourse performance. Future work is needed to assess the relationship between particular cognitive domains and discourse production as well as to investigate longitudinal changes to discourse production during stroke recovery.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20778541.

Macrostructural Aspects in Oral Narratives in Brazilian Portuguese by Left and Right Hemisphere Stroke Patients With Low Education and Low Socioeconomic Status

OBJECTIVE

Individuals with a stroke in either the left hemisphere (LH) or the right hemisphere (RH) often present macrostructural impairments in narrative abilities. Understanding the potential influence of low education and low socioeconomic status (SES) is critical to a more effective assessment of poststroke language. The first aim was to investigate macrostructural processing in low-education and low-SES individuals with stroke in the LH or RH or without brain damage. The second aim was to verify the relationships between macrolinguistic, neuropsychological, and sociodemographic variables.

METHOD

Forty-seven adults with LH (n = 15) or RH (n = 16) chronic ischemic stroke and 16 matched (age, education, and SES) healthy controls produced three oral picture-sequence narratives. The macrostructural aspects analyzed were cohesion, coherence, narrativity, macropropositions, and index of lexical informativeness and were compared among the three groups. Then, exploratory correlations were performed to assess associations between sociodemographic (such as SES), neuropsychological, and macrostructural variables.

RESULTS

Both the LH and the RH presented impairments in the local macrostructural aspect (cohesion), whereas the RH also presented impairments in more global aspects (global coherence and macropropositions). All five macrostructural variables correlated with each other, with higher correlations with narrativity. Naming was correlated with all macrostructural variables, as well as prestroke reading and writing habits (RWH), showing that higher naming accuracy and higher RWH are associated with better macrostructural skills.

CONCLUSIONS

The present results corroborate the role of the LH in more local processing and that of the RH in more global aspects of discourse. Moreover, this study highlights the importance of investigating discourse processing in healthy and clinical populations of understudied languages such as Brazilian Portuguese, with various levels of education, SES, and RWH.

Cognitive-communication disorder following right hemisphere damage: Narrative production

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Cognitive-communication disorder (CCD) is a common finding after RH damage.

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Alterations in discourse processing are highly prevalent in CCD.

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We analyzed 1,625 narratives to identify linguistic alterations related to RH lesions.

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The RH group produced narratives with more words, utterances, coherence errors, and lesser degree of information.

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CCD must be addressed through rehabilitation efforts to avoid restrictions on people's everyday life.

Background

Cognitive-communication disorder (CCD) results from the association of language and cognition impairment that may follow right hemisphere (RH) damage and impair the quality of life of affected persons.

Objective

We studied a set of 1,625 narratives produced by a cohort of 125 individuals (50 with a single right vascular lesion in the MCA territory and 75 cognitively healthy controls) using a task of picture-based discourse production. Discourse production was analyzed in its macro-and microlinguistic aspects to characterize better the linguistic mechanisms underlying RH patients' performance.

Results

The RH group produced more words and elocutions than controls, with a lower rate of informational content and a higher percentage of global coherence errors (all p-values <0.0001).

Conclusion

Individuals with RH lesions showed formal lexical and syntactic aspects of discourse mostly preserved. Alterations in the macrostructure of discourse prevailed over microstructural alterations in our sample, according to most literature studies. The group of individuals with RH lesions produced narratives containing more words and utterances, with a lesser degree of lexical information and more global coherence errors.

Benefit of Action Naming Over Object Naming for Visualization of Subcortical Language Pathways in Navigated Transcranial Magnetic Stimulation-Based Diffusion Tensor Imaging-Fiber Tracking

Visualization of functionally significant subcortical white matter fibers is needed in neurosurgical procedures in order to avoid damage to the language network during resection. In an effort to achieve this, positive cortical points revealed during preoperative language mapping with navigated transcranial magnetic stimulation (nTMS) can be employed as regions of interest (ROIs) for diffusion tensor imaging (DTI) fiber tracking. However, the effect that the use of different language tasks has on nTMS mapping and subsequent DTI-fiber tracking remains unexplored. The visualization of ventral stream tracts with an assumed lexico-semantic role may especially benefit from ROIs delivered by the lexico-semantically demanding verb task, Action Naming. In a first step, bihemispheric nTMS language mapping was administered in 18 healthy participants using the standard task Object Naming and the novel task Action Naming to trigger verbs in a small sentence context. Cortical areas in which nTMS induced language errors were identified as language-positive cortical sites. In a second step, nTMS-based DTI-fiber tracking was conducted using solely these language-positive points as ROIs. The ability of the two tasks’ ROIs to visualize the dorsal tracts Arcuate Fascicle and Superior Longitudinal Fascicle, the ventral tracts Inferior Longitudinal Fascicle, Uncinate Fascicle, and Inferior Fronto-Occipital Fascicle, the speech-articulatory Cortico-Nuclear Tract, and interhemispheric commissural fibers was compared in both hemispheres. In the left hemisphere, ROIs of Action Naming led to a significantly higher fraction of overall visualized tracts, specifically in the ventral stream’s Inferior Fronto-Occipital and Inferior Longitudinal Fascicle. No difference was found between tracking with Action Naming vs. Object Naming seeds for dorsal stream tracts, neither for the speech-articulatory tract nor the inter-hemispheric connections. While the two tasks appeared equally demanding for phonological-articulatory processes, ROI seeding through the task Action Naming seemed to better visualize lexico-semantic tracts in the ventral stream. This distinction was not evident in the right hemisphere. However, the distribution of tracts exposed was, overall, mirrored relative to those in the left hemisphere network. In presurgical practice, mapping and tracking of language pathways may profit from these findings and should consider inclusion of the Action Naming task, particularly for lesions in ventral subcortical regions.

An ERP study of hemispheric differences in perceptual representations of language reveals meaning attribution in the right hemisphere and constituents of the N400-effect

Recent findings have revealed that the right hemisphere (RH) is uniquely involved in integrating perceptual information from linguistic input to simulate a mental model of that input. We extend on these findings by testing whether meaning is generated from such models. Participants (N = 37) heard auditory passages describing the visuospatial arrangement of elements into a perceptual representation of a familiar object, then judged whether a laterally-presented target word matched the object. We found a central N400-effect for left visual-field targets, suggesting that meaning was also accessible to the RH. There was no statistical difference for right visual-field targets. Principle component analysis of the data revealed that the N400-effect was driven by positive components. Consequently, the results suggest that i) RH contributions to language comprehension include integrative and perceptual processes that enable overall meaning to be generated from representations of discourse, and ii) positive ERP components may produce N400-effects.

Neuroanatomical Correlates of Macrolinguistic Aspects in Narrative Discourse in Unilateral Left and Right Hemisphere Stroke: A Voxel-Based Morphometry Study

Background A growing body of literature has demonstrated the importance of discourse assessment in patients who suffered from brain injury, both in the left and right hemispheres, as discourse represents a key component of functional communication. However, little is known about the relationship between gray matter density and macrolinguistic processing. Purpose This study aimed to investigate this relationship in a group of participants with middle-low to low socioeconomic status. Method Twenty adults with unilateral left hemisphere (n = 10) or right hemisphere (n = 10) chronic ischemic stroke and 10 matched (age, education, and socioeconomic status) healthy controls produced three oral narratives based on sequential scenes. Voxel-based morphometry analysis was conducted using structural magnetic resonance imaging. Results Compared to healthy controls, the left hemisphere group showed cohesion impairments, whereas the right hemisphere group showed impairments in coherence and in producing macropropositions. Cohesion positively correlated with gray matter density in the right primary sensory area (PSA)/precentral gyrus and the pars opercularis. Coherence, narrativity, and index of lexical informativeness were positively associated with the left PSA/insula and the superior temporal gyrus. Macropropositions were mostly related to the left PSA/insula and superior temporal gyrus, left cingulate, and right primary motor area/insula. Discussion Overall, the present results suggest that both hemispheres are implicated in macrolinguistic processes in narrative discourse. Further studies including larger samples and with various socioeconomic status should be conducted. Supplemental Material https://doi.org/10.23641/asha.14347550.

Making Sense of Right Hemisphere Discourse Using RHDBank

PURPOSE

Right hemisphere brain damage (RHD) commonly causes pragmatic language disorders that are apparent in discourse production. Specific characteristics and approaches to assessment, diagnosis, and treatment of these disorders are not well-defined. RHDBank, a shared database of multimedia interactions for the study of communication using discourse, was created to address these gaps. The database, materials, and related analysis programs are free resources to clinicians, researchers, educators, and students.

METHOD

A standard discourse protocol was developed to elicit multiple types of discourse: free speech, conversation, picture description, storytelling, procedural discourse, and question-asking. Testing included measures of cognition, unilateral neglect, and communicative participation. Language samples were video-recorded and transcribed in CHAT format. Currently, the database includes 24 adults with RHD and 24 controls.

RESULTS

Illustrative analyses show how RHDBank can facilitate research using micro- and macrolinguistic discourse analysis techniques both within this population and across populations. Educational resources, such as the Grand Rounds tutorial, were developed using case studies from the database.

CONCLUSIONS

RHDBank is a shared database of resources that can facilitate educational and research efforts to address the gaps in knowledge about RHD communication and improve the clinical management of individuals with RHD.

Transcranial Direct-Current Stimulation May Improve Discourse Production in Healthy Older Adults

Background: The use of transcranial direct-current stimulation (tDCS) for therapeutic and neurorehabilitation purposes has become increasingly popular in recent years. Previous research has found that anodal tDCS may enhance naming ability and verbal fluency in healthy participants. However, the effect of tDCS on more functional, higher level language skills such as discourse production has yet to be understood. Aims: The present study aimed to investigate in healthy, older adults (a) the effect of anodal tDCS on discourse production vs. sham stimulation and (b) optimal electrode placement for tDCS to target language improvement at the discourse level. Methods: Fourteen healthy, older right-handed participants took part in this sham controlled, repeated measures pilot study. Each participant experienced three different experimental conditions; anodal tDCS on the left inferior frontal gyrus (IFG), anodal tDCS on the right IFG and sham stimulation while performing a story telling task. Significant changes in language performance before and after each condition were examined in three discourse production tasks: recount, procedural and narrative. Results: Left and right IFG conditions showed a greater number of significant within-group improvements (p < 0.05) in discourse production compared to sham with 6/12 for left IFG, 4/12 for right IFG and 2/12 for sham. There were no significant differences noted between tDCS conditions. No relationship was noted between language performance and physical activity, age, or gender. Conclusions: This study suggests that anodal tDCS may significantly improve discourse production in healthy, older adults. In line with previous tDCS language studies, the left IFG is highlighted as an optimal stimulation site for the modulation of language in healthy speakers. The findings support further exploration of tDCS as a rehabilitative tool for higher-level language skills in persons with aphasia.

Rapid automatized naming (RAN): effects of aging on a predictor of reading skill

Rapid Automatized Naming (RAN), a task in which participants must name a series of items as rapidly as possible, has been very useful as a measure of cognitive abilities that predict reading skill both in children and in young adults (YAs). This study examined RAN performance of 100 YAs and 80 cognitively healthy older adults (OAs). RAN performance was highly reliable but showed only a few weak correlations to other measures of individual differences used to study cognitive aging. RAN performance did not differ significantly by age group for symbolic RANs but was significantly slower for OAs than YAs for non-symbolic RANs. This pattern suggests that healthy aging is associated with little to no decline in the ability to sustain overlapping encoding and production of a sequence of items when it involves the form-to-form mapping required by symbolic RANs but with measurable decline in that ability when it involves the concept-to-form mapping required by non-symbolic RANs.

Visual narrative comprehension: Universal or not?

Visual narratives of sequential images - as found in comics, picture stories, and storyboards - are often thought to provide a fairly universal and transparent message that requires minimal learning to decode. This perceived transparency has led to frequent use of sequential images as experimental stimuli in the cognitive and psychological sciences to explore a wide range of topics. In addition, it underlines efforts to use visual narratives in science and health communication and as educational materials in both classroom settings and across developmental, clinical, and non-literate populations. Yet, combined with recent studies from the linguistic and cognitive sciences, decades of research suggest that visual narratives involve greater complexity and decoding than widely assumed. This review synthesizes observations from cross-cultural and developmental research on the comprehension and creation of visual narrative sequences, as well as findings from clinical psychology (e.g., autism, developmental language disorder, aphasia). Altogether, this work suggests that understanding the visual languages found in comics and visual narratives requires a fluency that is contingent on exposure and practice with a graphic system.

Idea Formulation for Spoken Language Production: The Interface of Cognition and Language

BACKGROUND

Language and communication are fundamental to the human experience, and, traditionally, spoken language is studied as an isolated skill. However, before propositional language (i.e., spontaneous, voluntary, novel speech) can be produced, propositional content or 'ideas' must be formulated.

OBJECTIVE

This review highlights the role of broader cognitive processes, particularly 'executive attention', in the formulation of propositional content (i.e., 'ideas') for propositional language production.

CONCLUSIONS

Several key lines of evidence converge to suggest that the formulation of ideas for propositional language production draws on executive attentional processes. Larger-scale clinical research has demonstrated a link between attentional processes and language, while detailed case studies of neurological patients have elucidated specific idea formulation mechanisms relating to the generation, selection and sequencing of ideas for expression. Furthermore, executive attentional processes have been implicated in the generation of ideas for propositional language production. Finally, neuroimaging studies suggest that a widely distributed network of brain regions, including parts of the prefrontal and parietal cortices, supports propositional language production.

IMPLICATIONS

Theoretically driven experimental research studies investigating mechanisms involved in the formulation of ideas are lacking. We suggest that novel experimental approaches are needed to define the contribution of executive attentional processes to idea formulation, from which comprehensive models of spoken language production can be developed. Clinically, propositional language impairments should be considered in the context of broader executive attentional deficits.

Editors’ Introduction and Review: Visual Narrative Research: An Emerging Field in Cognitive Science

Drawn sequences of images are among our oldest records of human intelligence, appearing on cave paintings, wall carvings, and ancient pottery, and they pervade across cultures from instruction manuals to comics. They also appear prevalently as stimuli across Cognitive Science, for studies of temporal cognition, event structure, social cognition, discourse, and basic intelligence. Yet, despite this fundamental place in human expression and research on cognition, the study of visual narratives themselves has only recently gained traction in Cognitive Science. This work has suggested that visual narrative comprehension requires cultural exposure across a developmental trajectory and engages with domain‐general processing mechanisms shared by visual perception, attention, event cognition, and language, among others. Here, we review the relevance of such research for the broader Cognitive Science community, and make the case for why researchers should join the scholarship of this ubiquitous but understudied aspect of human expression.

Drawn sequences of images, like those in comics and picture stories, are a pervasive and fundamental way that humans have communicated for millennia. Yet, the study of visual narratives has only recently gained traction in Cognitive Science. Here we explore what has held back the study of the cognition of visual narratives, and why researchers should join in scholarship of this ubiquitous aspect of expression.

Degenerative and Vascular Fluent Aphasia: Looking for Differences

OBJECTIVE

To investigate whether the characteristics of language disorders of degenerative and vascular aphasias depend on the underlying neuropathology.

METHODS

Logopenic variant/mixed primary progressive aphasics (lvmPPA; n=18) and poststroke fluent aphasics (PSA; n=11) underwent a neuropsychological examination and an assessment of the macro- and microlinguistic aspects of language. A principal component analysis and a cluster analysis applying a two-group solution were performed on the scores obtained from the neuropsychological and language examination.

RESULTS

Global cognition, lexical-semantic, and morphosyntactic components, and two components loading macrolinguistic variables, were extracted by the principal component analysis. A first cluster of 18 participants (14 lvmPPA and 4 PSA) and a second cluster of 11 participants (4 lvmPPA and 7 PSA) were identified. Participants in the first cluster were significantly more impaired than those in the second cluster in global cognition, lexical-semantic, and morphosyntactic components. Macrolinguistic components did not differentiate the two clusters. lvmPPA in the first cluster showed bilateral cortical thinning (greater on the left), whereas lvmPPA in the second cluster showed atrophy only in the left. Participants with PSA in both clusters showed vascular lesions encompassing the posterior left perisylvian regions. Underestimation of the severity of the leukoencephalopathy and damage of the interhemispheric connectivity might be responsible for the inclusion of PSA individuals in the first cluster, despite a unilateral lesion.

CONCLUSIONS

Lesion localization is the main factor that determines the characteristics of aphasic deficits. Etiology indirectly acts through a different sensitivity of the brain regions to various pathologies.

Differences in linguistic cohesion within the first year following right and left hemisphere lesions

BACKGROUND

Characterizing productive language deficits following lesions to the right (RH) or left hemispheres (LH) is valuable in identifying appropriate therapeutic goals. While damage to the LH classically is associated with deficits in language, RH lesions also result in changed communication beyond prosody due to cognitive-linguistic effects. Cohesion, reference to introduced content across sentences within discourse, relies on a listener's clear and unambiguous understanding that a reference has occurred. To date, we are not aware of any prior work that has compared patterns of cohesive strategy between RH and LH lesioned individuals with cohesion deficits.

AIMS

The purpose of the present study is to determine whether individuals with communication deficits following RH and LH lesions differ in the inclusion and clarity of cohesive markers.

METHODS & PROCEDURES

Seventy-six RH samples and 145 LH samples were used for comparison of cohesion performance in a Cookie Theft picture description task. Cohesive ties were assessed following the protocol outlined in Liles and Coelho (1998). It was hypothesized that individuals with LH lesions would present a different pattern of cohesion behaviour than RH lesioned individuals when considered both acutely and chronically.

OUTCOMES & RESULTS

Overall, samples from LH and RH groups did not differ in word counts or cohesive marker usage. However, the patterns of markers they chose to employ were different. LH samples used conjunctions and personal pronouns more frequently and used lexical cohesive markers less frequently than RH samples. Acutely, patterns of cohesive marker use between LH and RH samples were more similar. Chronically, LH samples contained more personal pronouns and the differences in lexical cohesive markers remained unchanged. When cohesion was unsuccessful, LH and RH damage were associated with different patterns of error. LH samples tended to omit information needed to clarify the intended referent, resulting in incomplete cohesion errors. RH samples tended to sustain breakdowns in cohesion from sentence to sentence, not resolving incorrectly chosen pronouns or ambiguities left in their samples.

CONCLUSIONS

LH and RH lesions resulted in differing patterns of chosen cohesive markers and errors when cohesion was unsuccessful. This was particularly true in lexical cohesion, which has been far less studied than closed-class cohesive markers like referential pronouns. It was also noted that cohesive behavior did not appear to "recover" for either group, suggesting spontaneous recovery is minimal and present strategies for language therapy may not effectively address this linguistic function.

Discourse in aging: Narrative and Persuasive

The growth in the elderly population has posed a social, economic and health challenge for the twenty-first century.

OBJECTIVE

Aging is often characterized by changes in cognitive functions which affect the receptive and expressive capabilities of language. Since language plays a significant role in human life, we evaluate the existence of age-related differences in narrative and persuasive discourses.

METHODS

The narrative discourse of 91 adults and persuasive discourse of 92 adults,aged from 19 to 75 years and stratified into four age groups,were examined.

RESULTS

There was a statistically significant difference between coherence in the elderly group and each of the other three age groups for both types of discourse. There was also a significant difference for the cohesion variable between the elderly and the first age group for narrative discourse only.

CONCLUSION

The results of this study demonstrate that discourse is influenced by aging and type (genre) of discourse task. Therefore, it is essential for clinicians to take into account the linguistic needs of elderly and incorporate these into their clinical programs. Also, this finding can help clinicians to distinguish between discourses of normal aging and other neurologic disorders (for example dementia, right hemisphere damage, aphasia).

The relationship between co-speech gesture production and macrolinguistic discourse abilities in people with focal brain injury

Brain damage is associated with linguistic deficits and might alter co-speech gesture production. Gesture production after focal brain injury has been mainly investigated with respect to intrasentential rather than discourse-level linguistic processing. In this study, we examined 1) spontaneous gesture production patterns of people with left hemisphere damage (LHD) or right hemisphere damage (RHD) in a narrative setting, 2) the neural structures associated with deviations in spontaneous gesture production in these groups, and 3) the relationship between spontaneous gesture production and discourse level linguistic processes (narrative complexity and evaluation competence). Individuals with LHD or RHD (17 people in each group) and neurotypical controls (n = 13) narrated a story from a picture book. Results showed that increase in gesture production for LHD individuals was associated with less complex narratives and lesions of individuals who produced more gestures than neurotypical individuals overlapped in frontal-temporal structures and basal ganglia. Co-speech gesture production of RHD individuals positively correlated with their evaluation competence in narrative. Lesions of RHD individuals who produced more gestures overlapped in the superior temporal gyrus and the inferior parietal lobule. Overall, LHD individuals produced more gestures than neurotypical individuals. The groups did not differ in their use of different gesture forms except that LHD individuals produced more deictic gestures per utterance than RHD individuals and controls. Our findings are consistent with the hypothesis that co-speech gesture production interacts with macro-linguistic levels of discourse and this interaction is affected by the hemispheric lateralization of discourse abilities.

Early Recovery of Aphasia through Thrombolysis: The Significance of Spontaneous Speech

BACKGROUND

Aphasia is one of the most devastating stroke-related consequences for social interaction and daily activities. Aphasia recovery in acute stroke depends on the degree of reperfusion after thrombolysis or thrombectomy. As aphasia assessment tests are often time-consuming for patients with acute stroke, physicians have been developing rapid and simple tests. The aim of our study is to evaluate the improvement of language functions in the earliest stage in patients treated with thrombolysis and in nontreated patients using our rapid screening test.

MATERIALS AND METHODS

Our study is a single-center prospective observational study conducted at the Stroke Unit of the University Medical Hospital of Trieste (January-December 2016). Patients treated with thrombolysis and nontreated patients underwent 3 aphasia assessments through our rapid screening test (at baseline, 24 hours, and 72 hours). The screening test assesses spontaneous speech, oral comprehension of words, reading aloud and comprehension of written words, oral comprehension of sentences, naming, repetition of words and a sentence, and writing words.

RESULTS

The study included 40 patients: 18 patients treated with thrombolysis and 22 nontreated patients. Both groups improved over time. Among all language parameters, spontaneous speech was statistically significant between 24 and 72 hours (P value = .012), and between baseline and 72 hours (P value = .017).

CONCLUSIONS

Our study demonstrates that patients treated with thrombolysis experience greater improvement in language than the nontreated patients. The difference between the 2 groups is increasingly evident over time. Moreover, spontaneous speech is the parameter marked by the greatest improvement.

Cohesive and coherent connected speech deficits in mild stroke

Spoken language production theories and lesion studies highlight several important prelinguistic conceptual preparation processes involved in the production of cohesive and coherent connected speech. Cohesion and coherence broadly connect sentences with preceding ideas and the overall topic. Broader cognitive mechanisms may mediate these processes. This study aims to investigate (1) whether stroke patients without aphasia exhibit impairments in cohesion and coherence in connected speech, and (2) the role of attention and executive functions in the production of connected speech. Eighteen stroke patients (8 right hemisphere stroke [RHS]; 6 left [LHS]) and 21 healthy controls completed two self-generated narrative tasks to elicit connected speech. A multi-level analysis of within and between-sentence processing ability was conducted. Cohesion and coherence impairments were found in the stroke group, particularly RHS patients, relative to controls. In the whole stroke group, better performance on the Hayling Test of executive function, which taps verbal initiation/suppression, was related to fewer propositional repetitions and global coherence errors. Better performance on attention tasks was related to fewer propositional repetitions, and decreased global coherence errors. In the RHS group, aspects of cohesive and coherent speech were associated with better performance on attention tasks. Better Hayling Test scores were related to more cohesive and coherent speech in RHS patients, and more coherent speech in LHS patients. Thus, we documented connected speech deficits in a heterogeneous stroke group without prominent aphasia. Our results suggest that broader cognitive processes may play a role in producing connected speech at the early conceptual preparation stage.

Narratives of focal brain injured individuals: A macro-level analysis

Focal brain injury can have detrimental effects on the pragmatics of communication. This study examined narrative production by unilateral brain damaged people (n=36) and healthy controls and focused on the complexity (content and coherence) and the evaluative aspect of their narratives to test the general hypothesis that the left hemisphere is biased to process microlinguistic information and the right hemisphere is biased to process macrolinguistic information. We found that people with left hemisphere damage's (LHD) narratives were less likely to maintain the overall theme of the story and produced fewer evaluative comments in their narratives. These deficits correlated with their performances on microlinguistic linguistic tasks. People with the right hemisphere damage (RHD) seemed to be preserved in expressing narrative complexity and evaluations as a group. Yet, single case analyses revealed that particular regions in the right hemisphere such as damage to the dorsolateral prefrontal cortex (DLPFC), the anterior and superior temporal gyrus, the middle temporal gyrus, and the supramarginal gyrus lead to problems in creating narratives. Our findings demonstrate that both hemispheres are necessary to produce competent narrative production. LHD people's poor production is related to their microlinguistic language problems whereas RHD people's impaired abilities can be associated with planning and working memory abilities required to relate events in a narrative.

Recovering two languages with the right hemisphere

Converging evidence suggests that the right hemisphere (RH) plays an important role in language recovery from aphasia after a left hemisphere (LH) lesion. In this longitudinal study we describe the neurological, cognitive, and linguistic profile of A.C., a bilingual who, after a severe traumatic brain injury, developed a form of fluent aphasia that affected his two languages (i.e., Romanian and Italian). The trauma-induced parenchymal atrophy led to an exceptional ventricular dilation that, gradually, affected the whole left hemisphere. A.C. is now recovering both languages relying only on his right hemisphere. An fMRI experiment employing a bilingual covert verb generation task documented the involvement of the right middle temporal gyrus in processes of lexical selection and access. This case supports the hypothesis that the RH plays a role in language recovery from aphasia when the LH has suffered massive lesions.

Communication Abilities Following Right Hemisphere Damage: Prevalence, Evaluation, and Profiles

It is now consensually accepted that the contribution of both hemispheres is required to reach a functional level of communication. The unilateralized view of language function, introduced more than a century ago, has since been complemented by clinical experience as well as neuro-imaging observations. Studies based on healthy and right-brain-damaged individuals assert the necessity to better describe, assess, and care for this broad population. Indeed, various neurological conditions, including stroke, traumatic brain injury (TBI), or neurodegenerative disease, can affect the right hemisphere (RH) and lead to distinct communication disorders. In the past 30 years, knowledge about communication assessment and, more recently, therapy designed for right-brain-damaged adults has drastically evolved. This manuscript aims at presenting the theoretical and clinical background that established the current expertise to support accurate assessment of communication following right brain damage. It is believed that a better understanding of the various profiles of impairments following a RH infract will allow speech-language pathologists (SLPs) to develop the clinical awareness necessary for appropriately taking care of these individuals.

Processing Sentences with Literal versus Figurative Use of Verbs: An ERP Study with Children with Language Impairments, Nonverbal Impairments, and Typical Development

Forty native Italian children (age 6-15) performed a sentence plausibility judgment task. ERP recordings were available for 12 children with specific language impairment (SLI), 11 children with nonverbal learning disabilities (NVLD), and 13 control children. Participants listened to verb-object combinations and judged them as acceptable or unacceptable. Stimuli belonged to four conditions, where concreteness and congruency were manipulated. All groups made more errors responding to abstract and to congruent sentences. Moreover, SLI participants performed worse than NVLD participants with abstract sentences. ERPs were analyzed in the time window 300-500 ms. SLI children show atypical, reversed effects of concreteness and congruence as compared to control and NVLD children, respectively. The results suggest that linguistic impairments disrupt abstract language processing more than visual-motor impairments. Moreover, ROI and SPM analyses of ERPs point to a predominant involvement of the left rather than the right hemisphere in the comprehension of figurative expressions.

Deficits in narrative discourse elicited by visual stimuli are already present in patients with mild cognitive impairment

Language batteries used to assess the skills of elderly individuals, such as naming and semantic verbal fluency, present some limitations in differentiating healthy controls from patients with amnestic mild cognitive impairment (a-MCI). Deficits in narrative discourse occur early in dementia caused by Alzheimer's disease (AD), and the narrative discourse abilities of a-MCI patients are poorly documented. The present study sought to propose and evaluate parameters for investigating narrative discourse in these populations. After a pilot study of 30 healthy subjects who served as a preliminary investigation of macro- and micro-linguistic aspects, 77 individuals (patients with AD and a-MCI and a control group) were evaluated. The experimental task required the participants to narrate a story based on a sequence of actions visually presented. The Control and AD groups differed in all parameters except narrative time and the total number of words recalled. The a-MCI group displayed mild discursive difficulties that were characterized as an intermediate stage between the Control and AD groups' performances. The a-MCI and Control groups differed from the AD group with respect to global coherence, discourse type and referential cohesion. The a-MCI and AD groups were similar to one another but differed from the Control group with respect to the type of words recalled, the repetition of words in the same sentence, the narrative structure and the inclusion of irrelevant propositions in the narrative. The narrative parameter that best distinguished the three groups was the speech effectiveness index. The proposed task was able to reveal differences between healthy controls and groups with cognitive decline. According to our findings, patients with a-MCI already present narrative deficits that are characterized by mild discursive difficulties that are less severe than those found in patients with AD.

Lexical diversity in Parkinson's disease

Background

Parkinson’s disease (PD) is a neurodegenerative syndrome of the basal ganglia (BG) believed to disrupt cortical-subcortical pathways critical to motor, cognitive and expressive language function. Recent studies have shown subtle deficits in expressive language performance among individuals with PD even in the earliest stage of the disease. The objective of this study was to use measures of lexical diversity to examine expressive language performance during discourse production in a sample of individuals with PD.

Methods

Twelve individuals with idiopathic Parkinson’s disease (PD) were compared to twelve matched, neurologically intact controls on measures of lexical diversity. Three minute discourse samples describing a typical day were collected and analyzed for lexical diversity with the CHILDES program using measures of type token ratio (TTR) and voc-D (D).

Results

Comparisons of three minute discourse samples indicated non-significant differences between individuals with PD and controls in word productivity (387 vs 356; p = .48). Similarly, there were also non-significant differences on measures of lexical diversity between the two groups (TTR = .45 vs.44; p = .50 and D 74 vs 68; p = .23).

Conclusions

These results suggest that lexical diversity during discourse production among individuals with PD is similar to non-neurological controls. These findings indicate that lexical diversity is an aspect of expressive language performance that is not impacted by the disease process in the earliest stages.

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.

Conversational Interaction in the Scanner: Mentalizing during Language Processing as Revealed by MEG

Humans are especially good at taking another's perspective-representing what others might be thinking or experiencing. This "mentalizing" capacity is apparent in everyday human interactions and conversations. We investigated its neural basis using magnetoencephalography. We focused on whether mentalizing was engaged spontaneously and routinely to understand an utterance's meaning or largely on-demand, to restore "common ground" when expectations were violated. Participants conversed with 1 of 2 confederate speakers and established tacit agreements about objects' names. In a subsequent "test" phase, some of these agreements were violated by either the same or a different speaker. Our analysis of the neural processing of test phase utterances revealed recruitment of neural circuits associated with language (temporal cortex), episodic memory (e.g., medial temporal lobe), and mentalizing (temporo-parietal junction and ventromedial prefrontal cortex). Theta oscillations (3-7 Hz) were modulated most prominently, and we observed phase coupling between functionally distinct neural circuits. The episodic memory and language circuits were recruited in anticipation of upcoming referring expressions, suggesting that context-sensitive predictions were spontaneously generated. In contrast, the mentalizing areas were recruited on-demand, as a means for detecting and resolving perceived pragmatic anomalies, with little evidence they were activated to make partner-specific predictions about upcoming linguistic utterances.

Doing resilience with "half a brain:" navigating moral sensibilities 35 years after hemispherectomy

This paper investigates experiences of resilience in the context of individuals suffering from disability as a result of severe intractable seizure disorder and consequent hemispherectomy, a surgical procedure in which part or all of either the left or right cerebral hemisphere is removed. Two adults who underwent childhood hemispherectomies-one left and one right-are the focus of this study. Previous research has extensively detailed the clinical outcomes of this neurological procedure, yet the actual day-to-day experiences of individuals living post-hemispherectomy remains unexplored. Utilizing open-ended, qualitative, and narrative techniques from a phenomenology of performativity perspective, the authors question how each individual's experiences of daily living are invariably acts of resilience, involving several different strategies that are somewhat unique to each. Rather than working as an adjective or noun signifying certain environmental or individual attributes, this paper proposes that "resilience" is best conceptualized as the individualized intentional actions which disabled, distraught, or at risk individuals perform in contextually relevant and idiosyncratic ways as they navigate health and well-being within their local social and moral worlds.

Hemispheric differences in the organization of memory for text ideas

The goal of this study was to examine hemispheric asymmetries in episodic memory for discourse. Access to previously comprehended information is essential for mapping incoming information to representations of "who did what to whom" in memory. An item-priming-in-recognition paradigm was used to examine differences in how the hemispheres represent discourse. Both hemispheres retained accurate information about concepts from short passages, but the information was organized differently. The left hemisphere was sensitive to the structural relations among concepts in a text, whereas the right hemisphere differentiated information that appeared in one passage from information that appeared in another. Moreover, the right hemisphere, but not the left hemisphere, retained information about the spatial/temporal proximity among concepts in a passage. Implications of these results for the roles of the right and left hemispheres in comprehending connected discourse are discussed.

Narrative discourse in anomic aphasia

Anomic aphasia is a disturbance affecting lexical retrieval. Nonetheless, persons with this disorder may also experience difficulties in the construction of coherent narratives. Whether this symptom is a sign of a macrolinguistic difficulty per se or reflects the lexical disorder is still an open debate. In order to analyze the effect of the lexical impairment on macrolinguistic processing, we compared the narrative skills of a group of ten participants with chronic anomic aphasia with those of ten healthy control individuals matched for age and educational level. The anomic participants produced narratives with lowered speech rate, reduced mean length of utterance, fewer grammatically well-formed sentences, more semantic paraphasias. The macrolinguistic analysis showed that they also produced more errors of cohesion and global coherence and fewer lexical information units. Interestingly, their levels of thematic selection were normal. A bivariate correlational analysis showed a strong correlation between the production of errors of cohesion and production of complete sentences, and between production of errors of global coherence and lexical information units. These correlations showed that aspects related to lexical retrieval may affect macrolinguistic processing during the construction of a narrative. Indeed, it is suggested that lexical deficits lead to two main consequences: First, patients with anomia frequently interrupt the utterances they are producing and this reduces the levels of sentence completeness and the overall degree of cohesion across the utterances; Second, they use strategies to cope with the lexical impairment and produce a quantity of lexical fillers and repetitions that, clustered in utterances, reduce the levels of global coherence.

Homotopic organization of essential language sites in right and bilateral cerebral hemispheric dominance

Object

Language dominance in the right hemisphere is rare. Therefore, the organization of essential language sites in the dominant right hemisphere is unclear, especially compared with cases involving the more prevalent left dominant hemisphere.

Methods

The authors reviewed the medical records of 15 patients who underwent awake craniotomy for tumor or epilepsy surgery and speech mapping of right hemisphere perisylvian language areas at the University of California, San Francisco. All patients were determined to have either complete right-sided or bilateral language dominance by preoperative Wada testing.

Results

All patients but one were left-handed. Of more than 331 total stimulation sites, 27 total sites were identified as essential for language function (14 sites for speech arrest/anarthria; 12 for anomia; and 1 for alexia). While significant interindividual variability was observed, the general pattern of language organization was similar to classic descriptions of frontal language production and posterior temporal language integration for the left hemisphere. Speech arrest sites were clustered in the ventral precentral gyrus and pars opercularis. Anomia sites were more widely distributed, but were focused in the posterior superior and middle temporal gyri as well as the inferior parietal gyrus. One alexia site was found over the superior temporal gyrus. Face sensory and motor cortical sites were also identified along the ventral sensorimotor strip. The prevalence and specificity of essential language sites were greater in unilateral right hemisphere–dominant patients, compared with those with bilateral dominance by Wada testing.

Conclusions

The authors' results suggest that the organization of language in right hemisphere dominance mirrors that of left hemisphere dominance. Awake speech mapping is a safe and reliable surgical adjunct in these rare clinical cases and should be done in the setting of right hemisphere dominance to avoid preventable postoperative aphasia.

Clinical Focus on Prosodic, Discursive and Pragmatic Treatment for Right Hemisphere Damaged Adults: What's Right?

Researchers and clinicians acknowledge today that the contribution of both cerebral hemispheres is necessary to a full and adequate verbal communication. Indeed, it is estimated that at least 50% of right brain damaged individuals display impairments of prosodic, discourse, pragmatics and/or lexical semantics dimensions of communication. Since the 1990's, researchers have focused on the description and the assessment of these impairments and it is only recently that authors have shown interest in planning specific intervention approaches. However, therapists in rehabilitation settings still have very few available tools. This review of recent literature demonstrates that, even though theoretical knowledge needs further methodological investigation, intervention guidelines can be identified to target right hemisphere damage communication impairments in clinical practice. These principles can be incorporated by speech and language pathologists, in a structured intervention framework, aiming at fully addressing prosodic, discursive and pragmatic components of communication.

Cerebral localization of functions and the neurology of language: fact versus fiction or is it something else?

Over the last 15 years there has been a burgeoning number of publications using functional brain imaging (>40,000 articles based on an ISI/Web of Science search) to localize behavioral and cognitive processes to specific areas in the human brain that are often not confirmed by traditional, lesion-based studies. Thus, there is a need to reassess what cerebral localization of functions is and is not. Otherwise, there is no rational way to interpret the escalating claims of localization in the functional imaging literature that is taking on the appearance of neurophysiologic "phrenology". This article will present arguments to suggest that functional localization in the brain is a robust but very dynamic, four-dimensional process. It is a learned phenomenon driven over time by large-scale, spatially distributed, neural networks seeking to efficiently maximize the processing, storage, and manipulation of information for cognitive and behavioral operations. Because of historical considerations and space limitations, the main focus will be on localization of language-related functions whose theoretical neurological basis can be generalized for any complex cognitive-behavioral function.

Introducing a communication assessment tool to Brazilian speech therapists: the MAC Battery

BACKGROUND

an assessment instrument to evaluate communication impairment after right brain damage: the Montreal Communication Evaluation Battery, an adapted brazilian version of the original canadian instrument--Protocole Montréal d'Evaluation de la Communication. Instruments that evaluate discursive, pragmatic, lexical-semantic and prosodic impairments are important for the diagnosis of communication disorders which are present in approximately 50% of the individuals with right brain damage. Systematic studies of the communication profile after lesions on this side of the brain have been carried out only during the last two decades.

AIM

to present the Montreal Communication Evaluation Battery to brazilian speech therapists.

CONCLUSION

the described instrument is an useful tool in the clinic for assessing four processes related to the communicative and linguistic abilities: discursive, pragmatic-inferential, lexical-semantic and prosodic components. It is has been normalized, validated and its reliability has been confirmed. Although this instrument was developed and adapted for diagnosing communication disorders in individuals with right brain damage people, it can also be helpful in investigating communication sequels in traumatic brain injury, dementia, bilateral frontal lesions, left-brain damage, psychopathologies, such as schizophrenia, among others.

The language of schizophrenia: an analysis of micro and macrolinguistic abilities and their neuropsychological correlates

Language disturbance is one of the main diagnostic features in schizophrenia and abnormalities of brain language areas have been consistently found in schizophrenic patients. The main aim of this study was to describe the impairment of micro and macrolinguistic abilities in a group of twenty-nine schizophrenic patients during the phase of illness stability compared to forty-eight healthy participants matched for age, gender and educational level. Microlinguistic abilities refer to lexical and morpho-syntactic skills, whereas macrolinguistic abilities relate to pragmatic and discourse level processing. Secondary aims were to detect the effect of macrolinguistic on microlinguistic ability, and the neuropsychological impairment associated with the linguistic deficit. The linguistic assessment was performed on story-telling. Three narratives were elicited with the help of a single-picture stimulus and two cartoon stories with six pictures each. A modified version of the Mental Deterioration Battery was used to assess selective cognitive performances. A series of t-tests indicated that all the macrolinguistic variables were significantly impaired in schizophrenic patients in at least one of the three story-tellings. Furthermore, the limited impairment found in microlinguistic abilities was influenced by macrolinguistic performance. Multivariate stepwise regression analyses suggested that reduced attention performances and deficit in executive functions were predictors of linguistic impairment. Language production in schizophrenia is impaired mainly at the macrolinguistic level of processing. It is disordered and filled with irrelevant pieces of information and derailments. Such erratic discourse may be linked to the inability to use pragmatic rules and to cognitive deficits involving factors such as attention, action planning, ordering and sequencing.

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.