Verbal pragmatics following unilateral stroke: emotional content and valence

Cognitive communication disorders after brain injury: A systematic COSMIN review of measurement instruments

BACKGROUND

There is a lack of consensus on standardized measurement instruments (MIs) for the assessment of cognitive communication disorders in individuals with acquired brain injury (ABI).

OBJECTIVES

To identify and describe the currently available MIs for the assessment of cognitive communication disorders in individuals with ABI and to evaluate the psychometric properties of MIs.

METHODS

A search was conducted in 6 databases on March 12, 2024 using a validated methodological search filter. We included studies that evaluated psychometric properties of MIs used to assess cognitive communication disorders in individuals with ABI. We applied the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) to evaluate the psychometric properties of the MIs.

RESULTS

We included 48 records reporting on 44 MIs. Of all MIs, the La Trobe Communication Questionnaire (LCQ) and the St Andrew's-Swansea Neurobehavioural Outcome Scale (SASNOS) were studied most extensively. No MIs had undergone exhaustive methodological evaluation.

CONCLUSIONS

Based on the COSMIN, only 1 of 44 MIs can be recommended as its results can be trusted. Most MIs have the potential to be recommended but require further research to assess their psychometric quality. The development of new tools is not necessary but further methodological studies should be conducted on promising tools. This review may help clinicians and researchers to select an MI for the assessment of cognitive communication disorders and may facilitate diagnosis and research.

TRIAL REGISTRATION

PROSPERO database (registration number: CRD42020196861). No funding.

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.

The effects of emotional stimuli on Word retrieval in people with aphasia

PURPOSE

Prior studies have shown that people with aphasia (PWA) have demonstrated superior language performance for emotional compared to nonemotional stimuli on a range of tasks, including auditory comprehension, verbal pragmatics, repetition, reading, and writing. However, studies on word retrieval, specifically, have suggested a possible interference effect of emotion on naming. The purpose of this study was to examine the effect of the emotional valence of stimuli on word retrieval in a series of naming tasks in PWA.

METHOD

Thirteen PWA and 13 neurotypical controls participated in four single-word naming tasks, including 1) object picture naming, 2) action picture naming, 3) category-member generation, and 4) verb generation. Each task included three valence sets of positively-, negatively-, and neutrally-rated pictures or words, which were obtained from the standardized International Affective Picture System (Lang et al., 2008) and the Affective Norms for Emotional Words (Bradley and Lang, 1999) databases. Accuracy and reaction time (RT) were measured and compared across groups, tasks, and valence sets.

RESULTS

Emotional stimuli, especially negative stimuli, resulted in worse naming performance, as measured by accuracy and RT, compared to nonemotional stimuli in PWA and neurotypical controls. This effect was relatively robust across the four naming tasks. In most cases, negative stimuli resulted in lower accuracy and slower RT than positive stimuli.

CONCLUSIONS

These findings suggest that stimulus valence may interfere with word retrieval for PWA and neurotypical adults and that this effect is robust across different types of naming tasks that vary by word class (nouns versus verbs) and stimulus type (pictures versus words). Negative stimuli resulted in worse naming performance than positive stimuli. These results suggest that emotionality of stimuli is an important variable to consider in word retrieval research.

A Scoping Review on the Effects of Emotional Stimuli on Language Processing in People With Aphasia

PURPOSE

Emotional stimuli have been shown to influence language processing (both language comprehension and production) in people with aphasia (PWA); however, this finding is not universally reported. Effects of emotional stimuli on language performance in PWA could have clinical and theoretical implications, yet the sparsity of studies and variability among them make it difficult to appraise the significance of this effect. The purpose of this scoping review was to (a) determine the extent and range of research examining the effect of emotional stimuli on language processing in PWA, (b) summarize and evaluate research findings, and (c) identify gaps in the literature that may warrant future study.

METHOD

PsycINFO, PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases were systematically searched for articles that compared performance in response to emotional and nonemotional stimuli on at least one language measure in one or more adults with aphasia. Data related to methods and results were extracted from each article and charted in Excel.

RESULTS

Five hundred forty unique articles were found, and 18 articles, consisting of 19 studies, met inclusion/exclusion criteria for this review. Of the 19 studies included, 11 studies reported enhanced performance on a language task for emotional compared to nonemotional stimuli, seven reported no difference, and one reported worse performance for emotional compared to nonemotional stimuli. Possible modulating variables such as task type, measurement, stimulus characteristics, and sample characteristics are discussed along with gaps in the literature.

CONCLUSION

The extent of research in this area is sparse; however, there does appear to be some early evidence for better performance in response to emotional over nonemotional stimuli in PWA for some, but not all, language processes investigated.

The Company Prosodic Deficits Keep Following Right Hemisphere Stroke: A Systematic Review

OBJECTIVES

The aim of this systematic review was to identify the presence and nature of relationships between specific forms of aprosodia (i.e., expressive and receptive emotional and linguistic prosodic deficits) and other cognitive-communication deficits and disorders in individuals with right hemisphere damage (RHD) due to stroke.

METHODS

One hundred and ninety articles from 1970 to February 2020 investigating receptive and expressive prosody in patients with relatively focal right hemisphere brain damage were identified via database searches.

RESULTS

Fourteen articles were identified that met inclusion criteria, passed quality reviews, and included sufficient information about prosody and potential co-occurring deficits. Twelve articles investigated receptive emotional aprosodia, and two articles investigated receptive linguistic aprosodia. Across the included studies, receptive emotional prosody was not systematically associated with hemispatial neglect, but did co-occur with deficits in emotional facial recognition, interpersonal interactions, or emotional semantics. Receptive linguistic processing was reported to co-occur with amusia and hemispatial neglect. No studies were found that investigated the co-occurrence of expressive emotional or linguistic prosodic deficits with other cognitive-communication impairments.

CONCLUSIONS

This systematic review revealed significant gaps in the research literature regarding the co-occurrence of common right hemisphere disorders with prosodic deficits. More rigorous empirical inquiry is required to identify specific patient profiles based on clusters of deficits associated with right hemisphere stroke. Future research may determine whether the co-occurrences identified are due to shared cognitive-linguistic processes, and may inform the development of evidence-based assessment and treatment recommendations for individuals with cognitive-communication deficits subsequent to RHD.

Effects of Positive and Negative Emotions on Picture Naming for People With Mild-to-Moderate Aphasia: A Preliminary Investigation

PURPOSE

The purpose of the study is to investigate how emotional arousal and valence affect confrontational naming accuracy and response time (RT) in people with mild-to-moderate aphasia compared with adults without aphasia. We hypothesized that negative and positive emotions would facilitate naming for people with aphasia (PWA) but lead to slower responses for adults with no aphasia.

METHOD

Eight participants with mild-to-moderate aphasia, 15 older adults (OAs), and 17 young adults (YAs) completed a confrontational naming task across three conditions (positive, negative, and neutral) in an ABA (where A = neutral and B = negative) case series design. Immediately following each naming condition, participants self-reported their perceived arousal and pleasure. Accuracy and RT were measured and compared.

RESULTS

As expected, PWA performed significantly less accurately and with longer RTs than both YA and OA groups across all conditions. However, opposite our hypothesis for the aphasia group, the negative condition resulted in decreased accuracy for the aphasia and the OA group and increased RT across all groups. No statistically significant differences were found between the positive and any other condition. Participants with aphasia who demonstrated an effect in the negative condition were observed to produce a larger proportion of semantically related errors than any other error types.

CONCLUSIONS

Findings suggest that strong negative emotions can interfere with semantic-lexical processing by diverting attentional resources to emotion regulation. Both clinicians and researchers should be aware of the potential influence of negative stimuli and negative emotional states on language performance for PWA, and these effects should be disentangled in future research. Further research should also be conducted with a larger number of participants with aphasia across a broader range of severity to replicate and extend findings.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19119356.

Evaluating informative content and global coherence in fluent and non-fluent aphasia

BACKGROUND

Discourse analysis is an important component of aphasia assessment because it can provide an insight into functional communication abilities. However, there are many unknowns regarding the levels of discourse breakdowns that occur across aphasia types. The purpose of the current study is to explore the possible differences in discourse-level communication in persons with fluent and non-fluent aphasia during picture description.

AIMS

To examine if persons with fluent and non-fluent aphasia differ on utterance-level discourse measures when evaluating informative content and global coherence. Additionally, to evaluate and compare the types of global coherence violations made by each group.

METHODS & PROCEDURES

Data from 31 people with aphasia was collected from AphasiaBank, which included 13 people with fluent aphasia and 18 people with non-fluent aphasia. Discourse samples from three picture descriptions were analysed. Discourse outcomes included utterances with new information (UNIs-relevant utterances containing new information) and global coherence (the extent to which each utterance maintained the overall discourse theme). Additionally, seven types of errors were identified to explore the nature of breakdowns in global coherence.

OUTCOMES & RESULTS

People with fluent aphasia produced significantly higher proportions of UNIs and had significantly higher average global coherence ratings than those with non-fluent aphasia. Differences in global coherence violations were identified with people with fluent aphasia producing more non-specific, incorrect and off-topic utterances and people with non-fluent aphasia producing more incomplete utterances. One of the most common global coherence error types in both groups was commentary.

CONCLUSIONS & IMPLICATIONS

Although people with fluent aphasia produced more types of global coherence errors, including incorrect, non-specific and off-topic utterances, the group was still rated significantly higher on utterance relevance and topic maintenance, indicating that the ability to produce a complete utterance plays an important role in some aspects of discourse production. Additionally, these findings provide an insight into potential targets for intervention.

An analysis of topics and vocabulary in Chinese oral narratives by normal speakers and speakers with fluent aphasia

This study analysed the topic and vocabulary of Chinese speakers based on language samples of personal recounts in a large spoken Chinese database recently made available in the public domain, i.e. Cantonese AphasiaBank ( http://www.speech.hku.hk/caphbank/search/ ). The goal of the analysis is to offer clinicians a rich source for selecting ecologically valid training materials for rehabilitating Chinese-speaking people with aphasia (PWA) in the design and planning of culturally and linguistically appropriate treatments. Discourse production of 65 Chinese-speaking PWA of fluent types (henceforth, PWFA) and their non-aphasic controls narrating an important event in their life were extracted from Cantonese AphasiaBank. Analyses of topics and vocabularies in terms of part-of-speech, word frequency, lexical semantics, and diversity were conducted. There was significant overlap in topics between the two groups. While the vocabulary was larger for controls than that of PWFA as expected, they were similar in distribution across parts-of-speech, frequency of occurrence, and the ratio of concrete to abstract items in major open word classes. Moreover, proportionately more different verbs than nouns were employed at the individual level for both speaker groups. The findings provide important implications for guiding directions of aphasia rehabilitation not only of fluent but also non-fluent Chinese aphasic speakers.

The dynamic opponent relativity model: an integration and extension of capacity theory and existing theoretical perspectives on the neuropsychology of arousal and emotion

Arousal theory as discussed within the present paper refers to those mechanisms and neural systems involved in central nervous system activation and more specifically the systems involved in cortical activation. Historical progress in the evolution of arousal theory has led to a better understanding of the functional neural systems involved in arousal or activation processes and ultimately contributed much to our current theories of emotion. Despite evidence for the dynamic interplay between the left and right cerebral hemispheres, the concepts of cerebral balance and dynamic activation have been emphasized in the neuropsychological literature. A conceptual model is proposed herein that incorporates the unique contributions from multiple neuropsychological theories of arousal and emotion. It is argued that the cerebral hemispheres may play oppositional roles in emotion partially due to the differences in their functional specializations and in their persistence upon activation. In the presence of a threat or provocation, the right hemisphere may activate survival relevant responses partially derived from hemispheric specializations in arousal and emotional processing, including the mobilization of sympathetic drive to promote heightened blood pressure, heart rate, glucose mobilization and respiratory support necessary for the challenge. Oppositional processes and mechanisms are discussed, which may be relevant to the regulatory control over the survival response; however, the capacity of these systems is necessarily limited. A limited capacity mechanism is proposed, which is familiar within other physiological systems, including that providing for the prevention of muscular damage under exceptional demand. This capacity theory is proposed, wherein a link may be expected between exceptional stress within a neural system and damage to the neural system. These mechanisms are proposed to be relevant to emotion and emotional disorders. Discussion is provided on the possible role of currently applied therapeutic interventions for emotional disorders.

Physiological and behavioural indices of hostility: an extension of the capacity model to include exposure to affective stress and right lateralized motor stress

Right hemisphere functional cerebral systems have reliably been associated with sympathetic nervous system arousal and the perception of negative affective events. The goal of the current research was to provide additional support for the capacity model of hostility by examining changes attributable to functional cerebral systems within the right hemisphere using a dual concurrent task paradigm. To incorporate exposure to negative affective and right-lateralized motor stress using this approach, high and low hostile individuals completed a series of grip-strength tasks before and after hearing a recording of angry infant vocalizations. Results supported the capacity model in that high hostile individuals were unable to maintain regulatory control over right hemisphere activation as indicated through increased motor perseveration in the pre- and post-affective stress conditions, heightened systolic blood pressure (SBP) upon exposure to negative emotional sounds, and increased heart rate (HR) following stress. Conversely, low hostile individuals showed improved regulatory control over these regions as evidenced by reduced motor perseveration in the pre- and post-affective stress conditions, maintenance of SBP and reductions in HR following stress. The current data support the capacity model and extend its scope to include exposure to affective and right-lateralized motor stress.

"Better But No Cigar": Persons with Aphasia Speak about their Speech

PURPOSE: This study examined responses of persons with aphasia (PWAs) to a general question about their speech. The goal was to describe their evaluative responses as positive, negative, or neutral/mixed and determine if responses differed, based on time post-onset, aphasia severity, and aphasia type. METHODS: 71 participants from the AphasiaBank project were included. As part of a larger protocol, investigators asked, "How do you think your speech is these days?" Responses were videotaped and transcribed using CLAN. Two authors coded the evaluative responses and categorized themes in the elaborative content provided by the participants. RESULTS: Positive responses accounted for 59% of all responses, followed by neutral/mixed (18%), and negative (17%). Participants also mentioned specific speech problems (35%), improvement (31%), and therapy (8%) in their responses. Time post-onset and aphasia type were not significantly associated with nature of response. Aphasia severity was significantly associated with nature of response, with higher AQ scores in the positive group and vice versa. CONCLUSIONS: The responses are discussed in the context of self-image and self-expression in PWA and social models in aphasia therapy. Results are also compared with those of others with chronic disabilities and research on resilience, positive affect, and optimism.

An extension of the functional cerebral systems approach to hostility: a capacity model utilizing a dual concurrent task paradigm

Regulatory control of emotions and expressive fluency (verbal or design) have historically been associated with the frontal lobes. Moreover, research has demonstrated the importance of cerebral laterality with a prominent role of the right frontal regions in the regulation of negative affect (anger, hostility) and in the fluent production of designs rather than verbal fluency. In the present research, participants identified with high and with low levels of hostility were evaluated on a design fluency test twice in one experimental session. Before the second administration of the fluency test, each participant underwent physiological (cold pressor) stress. It was hypothesized that diminished right frontal capacity in high-hostile men would be evident through lowered performance on this cognitive stressor. Convergent validity of the capacity model was supported wherein high-hostile men evidenced reduced delta magnitude over the right frontal region after exposure to the physiological stressor but failed to maintain consistent levels of right cerebral activation across conditions. The results suggest an inability for high-hostile men to maintain stable levels of cerebral activation after exposure to physiological and cognitive stress. Moreover, low-hostiles showed enhanced cognitive performance on the design task with lower levels of arousal (heightened delta magnitude). In contrast, reduced arousal yielded increased executive deficits in high-hostiles as evidenced through increased perseverative errors on the design fluency task.

Neuropragmatics: Extralinguistic pragmatic ability is better preserved in left-hemisphere-damaged patients than in right-hemisphere-damaged patients

The aim of the present study is to compare the pragmatic ability of right- and left-hemisphere-damaged patients excluding the possible interference of linguistic deficits. To this aim, we study extralinguistic communication, that is communication performed only through gestures. The Cognitive Pragmatics Theory provides the theoretical framework: it predicts a gradient of difficulty in the comprehension of different pragmatic phenomena, that should be valid independently of the use of language or gestures as communicative means. An experiment involving 10 healthy individuals, 10 right- and 9 left-hemisphere-damaged patients, shows that pragmatic performance is better preserved in left-hemisphere-damaged (LHD) patients than in right-hemisphere-damaged (RHD) patients.

Emotional arousal in agenesis of the corpus callosum

While the processing of verbal and psychophysiological indices of emotional arousal have been investigated extensively in relation to the left and right cerebral hemispheres, it remains poorly understood how both hemispheres normally function together to generate emotional responses to stimuli. Drawing on a unique sample of nine high-functioning subjects with complete agenesis of the corpus callosum (AgCC), we investigated this issue using standardized emotional visual stimuli. Compared to healthy controls, subjects with AgCC showed a larger variance in their cognitive ratings of valence and arousal, and an insensitivity to the emotion category of the stimuli, especially for negatively-valenced stimuli, and especially for their arousal. Despite their impaired cognitive ratings of arousal, some subjects with AgCC showed large skin-conductance responses, and in general skin-conductance responses discriminated emotion categories and correlated with stimulus arousal ratings. We suggest that largely intact right hemisphere mechanisms can support psychophysiological emotional responses, but that the lack of interhemispheric communication between the hemispheres, perhaps together with dysfunction of the anterior cingulate cortex, interferes with normal verbal ratings of arousal, a mechanism in line with some models of alexithymia.

Chapter 3 Beyond the face: exploring rapid influences of context on face processing

Humans optimize behavior by deriving context-based expectations. Contextual data that are important for survival are extracted rapidly, using coarse information, adaptive decision strategies, and dedicated neural infrastructure. In the field of object perception, the influence of a surrounding context has been a major research theme, and it has generated a large literature. That visual context, as typically provided by natural scenes, facilitates object recognition as has been convincingly demonstrated (Bar, M. (2004) Nat. Rev. Neurosci., 5: 617-629). Just like objects, faces are generally encountered as part of a natural scene. Thus far, the facial expression literature has neglected such context and treats facial expressions as if they stand on their own. This constitutes a major gap in our knowledge. Facial expressions tend to appear in a context of head and body orientations, body movements, posture changes, and other object-related actions with a similar or at least a closely related meaning. For instance, one would expect a frightened face when confronted to an external danger to be at least accompanied by withdrawal movements of head and shoulders. Furthermore, some cues provided by the environment or the context in which a facial expression appears may have a direct relation with the emotion displayed by the face. The brain may even fill in the natural scene context typically associated with the facial expression. Recognition of the facial expression may also profit from processing the vocal emotion as well as the emotional body language that normally accompany it. Here we review the emerging evidence on how the immediate visual and auditory contexts influence the recognition of facial expressions.

Effects of stimulus emotionality and sentence generation on memory for words in adults with unilateral brain damage

Does sentence generation and/or stimulus emotionality enhance verbal memory in patients with neurological impairment? This question was addressed by testing 40 patients with unilateral stroke (20 with left-brain and 20 with right-brain damage) and 20 healthy control participants for recall and recognition of 48 target words. During encoding, emotional and nonemotional words were either presented in sentences (read condition) or used to form sentences (generate condition). Both word emotionality and generative processing improved memory performance in all groups. The authors suggest that a similar influence (i.e., cognitive activation) underlies both of these memory-enhancing effects, although the putative origins of the 2 effects are quite different. Neuropsychological underpinnings and clinical implications of these phenomena are discussed.

Acoustical analysis of posed prosodic expressions: effects of emotion and sex

Prosodic expression is an important channel of emotional communication and can be assessed through computerized acoustical analysis. Fundamental frequency (F0) is the most commonly studied acoustic measure and considered the best index of perceived pitch. In this study, we examined two factors that can influence prosodic expression, sex and emotion type. A special feature is the use of a neutral expression as a control measure. We also described procedures for eliciting posed prosodic expression via an experimental task from the New York Emotion Battery. Subjects were healthy men (n=10) and women (n=9), matched for age (M=29.2 yr.) and education (M=15.6 yr.). Subjects were asked to intone neutral-content sentences with happy, sad, and neutral prosody. F0 mean and standard deviation were measured using the Computerized Speech Lab program. Initial findings indicated that women produced significantly higher F0 values than did men and that happy sentences were produced with significantly higher F0 values than were sad sentences. When semitone conversions were applied and neutral prosody was subtracted out, differences remained for emotion type but not for sex. Findings are discussed in terms of implications for the assessment and treatment of prosody in clinical populations.

Emotional processing deficits in individuals with unilateral brain damage

This article presents a review of the neural mechanisms underlying emotional processing deficits (EPDs) in individuals with unilateral brain damage. First, key theoretical issues pertaining to the neuropsychology of emotion are presented. These include parameters of emotional processing, the componential approach, emotional domains, and hypotheses regarding hemispheric specialization for emotion. Second, the literature on hemispheric asymmetries for emotion is reviewed in terms of processing mode (perception and expression) and communication channel (facial, prosodic-intonational, and lexical-verbal). Studies involving normal adults and individuals with right- or left-sided brain damage are reviewed. Third, recent findings identifying the role of the right hemisphere in emotional processing are described. The article is concluded by aligning these new data with findings from the general literature, providing added support for the right-hemisphere emotion hypothesis.

Hemispheric asymmetry in the processing of emotional content in word meanings: the effect of current and past depression

We examined hemispheric lateralization of emotion processing by comparing the performance of clinically depressed, previously depressed, and control individuals on a divided visual field task. Participants were asked to make affective valence judgments for each in a series of laterally presented person-descriptive adjectives. Study results suggest that the right cerebral hemisphere (RH) is preferentially sensitive to the affective context of language. Among targets presented to the RH, depressed and previously depressed participants were significantly faster and more accurate in their judgments of negative target words, while controls responded more quickly and accurately to positive target words. No such effects were observed for targets presented to the left hemisphere. It is hypothesized that affective sensitivity may result in differences in semantic network organization across individuals who vary in affective experience.

Psychometric aspects of verbal pragmatic ratings

This study examined the psychometric aspects of a verbal pragmatic rating scale. The scale contained six pragmatic features (i.e., Conciseness, Lexical Selection, Quantity, Relevancy, Specificity, and Topic Maintenance) based on Grice's cooperative principles. Fifteen right brain-damaged (RBD), 15 left brain-damaged (LBD), and 16 healthy normal control (NC) right-handed adult participants produced narratives while recollecting emotional and nonemotional experiences. Naive raters evaluated each pragmatic feature for appropriateness on a 5-point Likert scale. When reliability was examined, the overall internal consistency of the pragmatic scale was extremely high (alpha =.96). Factor analysis was conducted to examine the theoretical relations among the six pragmatic features. Three meaningful factors involving discourse content, conceptual unity, and parsimony were identified. Findings are discussed in light of Grice's model and the construct validity of the scale.