The Effects of Right Hemisphere Brain Damage on Question-Asking in Conversation

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.

Automation of Language Sample Analysis

PURPOSE

A major barrier to the wider use of language sample analysis (LSA) is the fact that transcription is very time intensive. Methods that can reduce the required time and effort could help in promoting the use of LSA for clinical practice and research.

METHOD

This article describes an automated pipeline, called Batchalign, that takes raw audio and creates full transcripts in Codes for the Human Analysis of Talk (CHAT) transcription format, complete with utterance- and word-level time alignments and morphosyntactic analysis. The pipeline only requires major human intervention for final checking. It combines a series of existing tools with additional novel reformatting processes. The steps in the pipeline are (a) automatic speech recognition, (b) utterance tokenization, (c) automatic corrections, (d) speaker ID assignment, (e) forced alignment, (f) user adjustments, and (g) automatic morphosyntactic and profiling analyses.

RESULTS

For work with recordings from adults with language disorders, six major results were obtained: (a) The word error rate was between 2.4% for controls and 3.4% for patients, (b) utterance tokenization accuracy was at the level reported for speakers without language disorders, (c) word-level diarization accuracy was at 93% for control participants and 83% for participants with language disorders, (d) utterance-level diarization accuracy based on word-level diarization was high, (e) adherence to CHAT format was fully accurate, and (f) human transcriber time was reduced by up to 75%.

CONCLUSION

The pipeline dramatically shortens the time gap between data collection and data analysis and provides an output superior to that typically generated by human transcribers.

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

BACKGROUND

Right hemisphere communication disorders are neither consistently labelled nor adequately defined. Labels associated with right hemisphere brain damage (RHD) are broad and fail to capture the essence of communication challenges needed for stroke-related service provisions. Determination of rehabilitation needs and best-practice guidelines for the education, management and functional improvement of communication disorders after RHD are all predicated on an apt diagnostic label and disorder characteristics.

AIMS

In this paper apragmatism is proposed as a potential communication-specific diagnostic label for the impairments in communication that occur after RHD. In particular, the researchers aimed: (1) to establish an operational definition of apragmatism; and (2) to describe the linguistic, paralinguistic and extralinguistic communication deficits under the umbrella term apragmatism.

METHODS & PROCEDURES

An international collaborative of researchers with expertise in RHD followed a multilevel approach to consider the utility of apragmatism as a diagnostic label. Adopting the relational approach to concept mapping, the researchers engaged in a series of group meetings to complete four levels of mapping: (1) identify and review, (2) define, (3) expert discussion and (4) label determination.

MAIN CONTRIBUTION

Apragmatism was established as a suitable diagnostic label for the impairments in communication associated with RHD. The paper offers an operational definition and description of the linguistic, paralinguistic and extralinguistic features of apragmatism through evidence summaries and examples from people with RHD retrieved from the RHDBank.

CONCLUSIONS & IMPLICATIONS

The adoption of the term apragmatism offers an opportunity to capture the hallmark of RHD communication deficits. The use of the term is recommended when referencing the pragmatic language impairments in this population. Apragmatism, which may co-occur with or be exacerbated by cognitive impairments, can interfere with the ability to interpret and convey intended meaning and impact the lives of right hemisphere stroke survivors and their families.

WHAT THIS PAPER ADDS

What is already known on the subject RHD results in a heterogeneous group of deficits that range in cognitive-communicative complexity. Many of the deficits are subsumed under pragmatics. For example, adults with RHD may demonstrate tangential or verbose communication, insensitivity to others' needs and feelings, prosodic changes, minimal gesture use and facial expression, and more. While descriptions of pragmatic impairments pervade the literature, there is no consistently used diagnostic label. The clinical consequences of this absence include difficulty with inter- and intra-disciplinary communication about these patients, difficulty consolidating findings across research studies, and challenges in communicating about these pragmatic changes with patients, families and other stakeholders. What this paper adds to existing knowledge The term apragmatism is proposed as a diagnostic label to consistently describe pragmatic communication changes after RHD. Apragmatism is characterized using three components of pragmatics: linguistic, paralinguistic and extralinguistic. Descriptions and examples of these three components are provided with supplemental transcripts retrieved from the RHDBank. What are the potential or actual clinical implications of this work? Adoption of the term apragmatism by speech and language therapists and other medical and rehabilitation professionals has the potential to provide consistency in describing the abilities and challenges experienced by people following a right hemisphere stroke. Such improvements may help drive the development of evidence-based assessments and treatments for this population.

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.

Clinical Guidelines for Eliciting Discourse Using the RHDBank Protocol

PURPOSE

Examining discourse after right hemisphere brain damage (RHD) can provide invaluable clinical data and insight into functional communication capabilities. Yet, clinicians preparing to enter the field may have limited experience eliciting and analyzing discourse for therapeutic purposes. The purpose of this work is to present a practical guide for the clinical use of the RHDBank protocol.

METHOD

Following a brief overview of the RHDBank protocol, elicitation guidelines and protocol administration considerations are offered. Measures that should be considered when analyzing RHDBank-elicited discourse are summarized. The RHDBank protocol is positioned as an accessible resource for discourse elicitation in the clinical setting, and examples for the clinical use of the protocol are provided.

CONCLUSIONS

Discourse production can be a key source of information regarding communication ability following RHD. The RHDBank provides a structured and scripted approach to the clinical elicitation of language and consideration of discourse production. Its immediate clinical utility will assist developing clinicians with the acquisition of a clinically relevant elicitation approach and more comprehensive view of the RHD communication impairments. Application of the protocol can aid in collective knowledge advancement that will promote a better understanding of RHD language production as a clinical entity with an array of possible characteristics.