Aprosodia Subsequent to Right Hemisphere Brain Damage: A Systematic Review and Meta-Analysis.

OBJECTIVE: To identify which aspects of prosody are negatively affected subsequent to right hemisphere brain damage (RHD) and to evaluate the methodological quality of the constituent studies. METHOD: Twenty-one electronic databases were searched to identify articles from 1970 to February 2020 by entering keywords. Eligibility criteria for articles included a focus on adults with acquired RHD, prosody as the primary research topic, and publication in a peer-reviewed journal. A quality appraisal was conducted using a rubric adapted from Downs and Black (1998). RESULTS: Of the 113 articles appraised as eligible and appropriate for inclusion, 71 articles were selected to undergo data extraction for both meta-analyses of population effect size estimates and qualitative synthesis. Across all domains of prosody, the effect estimate was g = 2.51 [95% CI (1.94, 3.09), t = 8.66, p < 0.0001], based on 129 contrasts between RHD and non-brain-damaged healthy controls (NBD), indicating a significant random effects model. This effect size was driven by findings in emotional prosody, g = 2.48 [95% CI (1.76, 3.20), t = 6.88, p < 0.0001]. Overall, studies of higher quality (rpb = 0.18, p < 0.001) and higher sample size/contrast ratio (rpb = 0.25, p < 0.001) were more likely to report significant differences between RHD and NBD participants. CONCLUSIONS: The results confirm consistent evidence for emotional prosody deficits in the RHD population. Inconsistent evidence was observed across linguistic prosody domains and pervasive methodological issues were identified across studies, regardless of their prosody focus. These findings highlight the need for more rigorous and sufficiently high-powered designs to examine prosody subsequent to RHD, particularly within the linguistic prosody domain.

Influence of Language of Administration on ImPACT Performance by Bilingual Spanish-English College Students.

Previous research has suggested that there are performance differences on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery related to language of administration, such that scores are higher with the English than the Spanish version of the battery. This study extended those findings in a within-subjects design, evaluating neurocognitive performance of 58 bilingual English-Spanish-speaking individuals who completed ImPACT in both languages. Results revealed a significant multivariate effect of language of test administration, p < .01; partial η(2) = 0.23, with significantly better English language performance on Verbal Memory and Visual Motor Speed composite scores, but not Visual Memory, Reaction Time, or Total Symptom score. Results are discussed in relation to potential linguistic biases of the ImPACT and functional language dominance that may contribute to the lower scores. These results extend previous findings and suggest a need for separate normative data for Spanish-speaking individuals completing the ImPACT battery if baseline data are not present.

An evidence-based systematic review on communication treatments for individuals with right hemisphere brain damage.

PURPOSE: The purpose of this review is to evaluate and summarize the research evidence related to the treatment of individuals with right hemisphere communication disorders. METHOD: A comprehensive search of the literature using key words related to right hemisphere brain damage and communication treatment was conducted in 27 databases (e.g., PubMed, CINAHL). On the basis of a set of pre-established clinical questions, inclusion/exclusion criteria, and search parameters, studies investigating sentence- or discourse-level treatments were identified and evaluated for methodological quality. Data regarding participant, intervention, and outcome variables were reported. RESULTS: Only 5 studies were identified, each representing a different sentence- or discourse-level treatment approach and reporting a wide range of prosodic, expressive, receptive, and pragmatic outcomes. CONCLUSION: Although the state of the evidence pertaining to right hemisphere communication treatments is at a very preliminary stage, some positive findings were identified to assist speech-language pathologists who are working with individuals with right hemisphere brain damage. Clinical implications and recommendations for future research are explored.

Clinical relevance of discourse characteristics after right hemisphere brain damage.

PURPOSE: Discourse characteristics of adults with right hemisphere brain damage are similar to those reported for healthy older adults, prompting the question of whether changes are due to neurological lesions or normal aging processes. The clinical relevance of potential differences across groups was examined through ratings by speech-language pathologists. METHOD: A thinking-out-loud task was used to elicit discourse from 8 individuals with right brain damage and 8 healthy older adults. Speech-language pathologists rated discourse transcripts on content and quantity variables and then classified them as belonging to a participant with or without brain damage. Subjective ratings were validated against corroborating measures. RESULTS: Discourse produced by adults with right brain damage was rated as more tangential and egocentric than that from healthy older adults. Extreme verbosity or paucity of speech was attributed to people with right brain damage. One third of the speech-language pathologists accurately classified discourse samples according to group, whereas the others displayed biases toward one group or the other. CONCLUSIONS: Tangentiality, egocentrism, and extremes of quantity are clinically relevant characteristics of discourse produced by adults with right brain damage. Speech-language pathologists must be aware of potential biases that influence their perception of "normal" discourse production.

Inference generation during text comprehension by adults with right hemisphere brain damage: activation failure versus multiple activation.

Evidence conflicts as to whether adults with right hemisphere brain damage (RHD) generate inferences during text comprehension. M. Beeman (1993) reported that adults with RHD fail to activate the lexical-semantic bases of routine bridging inferences, which are necessary for comprehension. But other evidence indicates that adults with RHD activate multiple interpretations in various comprehension domains. In addition, the activation of contextually inappropriate interpretations is prolonged for many adults with RHD and predicts poor discourse comprehension. This study contrasted Beeman's activation failure hypothesis with the prediction that adults with RHD would generate multiple interpretations in text comprehension. The relation between activation of textually incompatible inferences and discourse comprehension was also investigated for this group. Thirty-seven adults with RHD and 34 without brain damage listened to brief narratives that required a bridging inference (BI) to integrate the text-final sentence. This final sentence, when isolated from its text, was strongly biased toward a contextually incompatible alternate interpretation (AI). Auditory phoneme strings were presented for lexical decision immediately after each text's initial and final sentence. Adults with RHD were both faster and more accurate in making lexical decisions to BI-related target words in final-sentence position than in initial-sentence position. Thus, contrary to the activation failure hypothesis, adults with RHD generated the lexical-semantic foundations of BIs where they were required by the text. AI generation was evident in accuracy data as well, but not in response time data. This result is partially consistent with the multiple activation view. Finally, greater activation for contextually incompatible interpretations was associated with poorer discourse comprehension performance by adults with RHD.

Affective language and humor appreciation after right hemisphere brain damage.

Many adults with right hemisphere brain damage exhibit difficulties in the comprehension and expression of emotional language and humor. Affective comprehension deficits range in severity and can be modulated by task and response demands as well as by the strength of emotional content. Expressive emotional language deficits, as characterized by reduced emotional intensity, are more pervasive than comprehension deficits. Deficits in humor appreciation generally affect the ability to integrate an incongruous element (e.g., a punch line) with the preceding context. Several co-occurring disorders (e.g., depression, cognitive and visuoperceptual deficits, and reduced auditory comprehension) may exacerbate problems with affective language and humor. Although some formal measures evaluate humor appreciation, none specifically addresses emotional language. While no hard data exist regarding efficacy of treatment for deficits in affective language or humor processing, several suggestions for such treatment are provided.