Apragmatism: The renewal of a label for communication disorders associated with right hemisphere brain damage

Right brain hemisphere lesions affecting language functioning in the acute phase of stroke recovery: A Croatian survey

Greater empirical and scientific attention is still put on patients with left brain hemisphere (LBH) damage where language impairments are common and expected. In patients with RBH damage, language assessment is therefore rarely done in the acute phase of stroke recovery.

PURPOSE

To investigate language impairments in the acute phase of stroke using a Croatian standardized language battery for the first time and compare patients with RBH stroke, LBH stroke and healthy individuals.

METHODS

This study compares language functioning in three groups of conveniently sampled participants: RBH stroke patients, LBH stroke patients and healthy individuals. Kruskal Wallis H test was used to evaluate a combined group comparison, after which a post-hoc Dunn test was performed.

RESULTS

Patients with RBH stroke scored significantly lower than healthy individuals on the CAT:HR in verbal fluency, comprehension of written sentences, naming, and total production. In addition, comprehension of written and spoken sentences did not differ between patients with RBH and LBH stroke patients which suggests the existence of language impairment (p>.05).

CONCLUSION

RBH stroke can significantly impair language comprehension and production in the acute phase of stroke recovery emphasizing the importance of early detection.

Practical Strategies to Optimize Cognitive-Communication Intervention in Complex Real-World Conditions: A Life Integration Approach

PURPOSE

Cognitive-communication intervention (CCI) service gaps compromise quality of life for individuals with acquired brain injuries. Speech-language pathologists (SLPs) must examine barriers to care and develop solutions to address current problems in awareness of cognitive-communication disorders, understanding of SLP services, access and referral mechanisms, and care pathways. They must also adapt CCI to the complexities and constraints of daily life. In this article, we explore actions that clinical SLPs can take to overcome service barriers and advocate for fair, timely, and evidence-based CCI.

METHOD

This clinical focus article examines barriers to CCI and provides a set of tools and strategies SLPs can employ to address them. These strategies are organized into a framework called the Life Integration Approach (LIA), which has 10 elements to guide clinical service planning: (a) evidence application, (b) communication education and assertiveness, (c) access and referral, (d) assessment, (e) therapeutic engagement, (f) cognitive-communication goal setting, (g) instructional practices, (h) life integration, (i) communication partner collaboration, and (j) resource allocation. Resources are provided to demonstrate how the LIA can integrate advocacy with clinical service while adapting to complex conditions of life, competing priorities, and service constraints.

RESULTS AND CONCLUSION

Although barriers to provision of quality SLP CCI may seem formidable, there are practical actions SLPs can take to advocate for and adapt CCI services to life demands for individuals living with the devastating effects of brain injury.

The Right ICD Code, Right Now: A Call to Action for Pragmatic Language Disorders After Right Hemisphere Stroke

PURPOSE

Diagnosis of language impairments after stroke is important to optimizing stroke outcomes. After right hemisphere brain damage (RHD), apragmatism can impact the comprehension and production of pragmatic language. However, despite decades of empirical evidence, there is no International Classification of Diseases (ICD) code for RHD pragmatic language impairments. The absence of an ICD code has far reaching ramifications that impact patient outcomes, including reduced clinical and public awareness, limited curricular content, and underdiagnosis. This viewpoint justifies the need to appropriately classify the pragmatic language symptomology after RHD with an ICD code.

CONCLUSION

An ICD code can positively influence health care practitioner knowledge, education, and practice while informing public health considerations vital to epidemiological analyses.

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.

Identifying Spatial Neglect in Chronic Right Hemisphere Stroke Survivors Using the RHDBank Outcomes

PURPOSE

The chronicity of spatial neglect (SN) and the utility of existing diagnostic measures used by speech-language pathologists remain poorly understood. In this retrospective study, we examined how the RHDBank test battery informs the identification of SN after right hemisphere brain damage (RHD) during the chronic phase of recovery.

METHOD

Data from 29 right hemisphere stroke survivors were extracted from the RHDBank, including SN tests, for which we performed laterality index scoring: a 51-item demographic survey, the Apples Test, the Indented Paragraph Test, and the clock drawing task from the Cognitive Linguistic Quick Test (CLQT). Two groups (SN+ and SN-) were identified using the Apples Test. A hierarchical cluster analysis explored CLQT performance clusters in association with SN, and group comparisons of demographic variables and test scores were conducted.

RESULTS

Ten patients were identified as having SN+ (34%) using the Apples Test. The Indented Paragraph Test and the CLQT's clock drawing test identified only two of the 20 stroke survivors with SN+. Cluster analyses showed that domain and task scores on the CLQT carried information to classify participants into SN+ and SN- in concordance with performance on the Apples Test. Participants in the SN+ cluster had moderately impaired attention and executive function skills and mildly impaired visuospatial skills.

CONCLUSIONS

The Apples Test differentiated SN in a group of chronic right hemisphere stroke survivors. Using multiple measures from the CLQT seemed to capture a greater range of problems than clock drawing and paragraph reading tests alone. Therefore, the RHDBank test battery as a whole-and in part the CLQT, Apples Test, and Indented Paragraph Test-can detect certain subtypes of SN in the chronic deficit profile after RHD and is a starting point for diagnostic integration by speech-language pathologists.

Resting state correlates of picture description informativeness in left vs. right hemisphere chronic stroke

Introduction

Despite a growing emphasis on discourse processing in clinical neuroscience, relatively little is known about the neurobiology of discourse production impairments. Individuals with a history of left or right hemisphere stroke can exhibit difficulty with communicating meaningful discourse content, which implies both cerebral hemispheres play a role in this skill. However, the extent to which successful production of discourse content relies on network connections within domain-specific vs. domain-general networks in either hemisphere is unknown.

Methods

In this study, 45 individuals with a history of either left or right hemisphere stroke completed resting state fMRI and the Cookie Theft picture description task.

Results

Participants did not differ in the total number of content units or the percentage of interpretative content units they produced. Stroke survivors with left hemisphere damage produced significantly fewer content units per second than individuals with right hemisphere stroke. Intrinsic connectivity of the left language network was significantly weaker in the left compared to the right hemisphere stroke group for specific connections. Greater efficiency of communication of picture scene content was associated with stronger left but weaker right frontotemporal connectivity of the language network in patients with a history of left hemisphere (but not right hemisphere) stroke. No significant relationships were found between picture description measures and connectivity of the dorsal attention, default mode, or salience networks or with connections between language and other network regions.

Discussion

These findings add to prior behavioral studies of picture description skills in stroke survivors and provide insight into the role of the language network vs. other intrinsic networks during discourse production.

Exploring Pragmatic Deficits in Relation to Theory of Mind and Executive Functions: Evidence from Individuals with Right Hemisphere Stroke

Research investigating pragmatic deficits in individuals with right hemisphere damage focuses on identifying the potential mechanisms responsible for the nature of these impairments. Nonetheless, the presumed shared cognitive mechanisms that could account for these deficits have not yet been established through data-based evidence from lesion studies. This study aimed to examine the co-occurrence of pragmatic language deficits, Theory of Mind impairments, and executive functions while also exploring their associations with brain lesion sites. Twenty-five patients suffering from unilateral right hemisphere stroke and thirty-seven healthy participants were recruited for this study. The two groups were tested in pragmatics, Theory of Mind, and executive function tasks. Structural imaging data were also obtained for the identification of the lesion sites. The findings of this study suggest a potential convergence among the three aforementioned cognitive mechanisms. Moreover, we postulate a hypothesis for a neural circuitry for communication impairments observed in individuals with right hemisphere damage.

Language-Specific Dual-Task Effects After Stroke: A Systematic Review

PURPOSE

The dual-task paradigm has been frequently used to examine stroke-related deficits because it samples behavioral performance under conditions of distraction similar to functioning in real-life environments. This original systematic review synthesizes studies that examined dual-task effects involving spoken language production in adults affected by stroke, including transient ischemic attack (TIA) and poststroke aphasia.

METHOD

Five databases were searched (inception to March 2022) for eligible peer-reviewed articles. The 21 included studies reported a total of 561 stroke participants. Thirteen studies focused on single word production, for example, word fluency, and eight on discourse production, for example, storytelling. Most studies included participants who had suffered a major stroke. Six studies focused on aphasia, whereas no study focused on TIA. A meta-analysis was not appropriate because of the heterogeneity of outcome measures.

RESULTS

Some single word production studies found dual-task language effects whereas others did not. This finding was compounded by the lack of appropriate control participants. Most single word and discourse studies utilized motoric tasks in the dual-task condition. Our certainty (or confidence) assessment was based on a methodological appraisal of each study and information about reliability/fidelity. As 10 of the 21 studies included appropriate control groups and limited reliability/fidelity information, the certainty of the findings may be described as weak.

CONCLUSIONS

Language-specific dual-task costs were identified in single word studies, especially those that focused on aphasia as well as half of the nonaphasia studies. Unlike single word studies, nearly all studies of discourse showed dual-task decrements on at least some variables.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23605311.

Intersectionality of Race and Question-Asking in Women After Right Hemisphere Brain Damage

PURPOSE

Atypical pragmatic language can impede quality health care access. Right hemisphere brain damage (RHD) results in changes in pragmatic language use; however, little is known about whether there are racial/ethnic influences. Recent research indicated differences in question-asking when RHD survivors were compared with healthy controls, prompting the current examination of question production in women by race/ethnicity and the presence of RHD.

METHOD

Participants were eight Black and eight White women who sustained a single right hemisphere stroke at least 6 months prior to data collection (2016-2020), and eight Black and eight White control participants from the Right Hemisphere Damage Bank (https://rhd.talkbank.org). Videos of informal, first-encounter conversational discourse tasks were transcribed and coded. Analyses were conducted for frequency of questions and question type.

RESULTS

Race/ethnicity had a statistically significant effect on the total number of questions and number of content and polar questions. The mean total of questions, number of content questions, and mean number of polar questions for Black participants was significantly less than White participants. There was less variability in question type for Black participants than White participants, and a tendency for Black participants to ask fewer questions regardless of RHD or control status.

CONCLUSIONS

Acquisition of health information and ensuing health care might be less fruitful for Black women communicating with someone who may not know to conduct comprehension checks and be proactive in provision of information. To be culturally responsive to Black patients with communication disorders, providers might apply this awareness of reduced question-asking to their strategies to improve patient-provider communication.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21809475.