Right hemisphere damage and other-initiated repair in everyday conversation

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.

Interactive repair and the foundations of language

The robustness and flexibility of human language is underpinned by a machinery of interactive repair. Repair is deeply intertwined with two core properties of human language: reflexivity (it can communicate about itself) and accountability (it is used to publicly enforce social norms). We review empirical and theoretical advances from across the cognitive sciences that mark interactive repair as a domain of pragmatic universals, a key place to study metacognition in interaction, and a system that enables collective computation. This provides novel insights into the role of repair in comparative cognition, language development, and human-computer interaction. As an always-available fallback option and an infrastructure for negotiating social commitments, interactive repair is foundational to the resilience, complexity, and flexibility of human language.

Effect of right hemispheric damage on structured spoken conversation

Patients with right hemisphere damage (RHD) occasionally complain of difficulties in conversation. A conversation is a type of communication between the speaker and listener, and several elements are required for a conversation to take place. However, it is unclear which of those elements affect communication in patients with RHD. Therefore, we prospectively enrolled 11 patients with right hemispheric damage due to acute cerebral infarction, within 1 week of onset. To evaluate patients’ conversational abilities, we used a structured conversation task, namely, the “Hallym Conversation and Pragmatics Protocol”. The topics of conversation were “family”, “leisure”, and “other/friends”. The conversation characteristics were classified according to three indices: the “conversational participation index”, “topic manipulation index”, and “conversational breakdown index”. Patients with RHD were compared with 11 age-, sex-, and years of education-matched healthy adults. The most common site of damage in the patients with RHD was the periventricular white matter. There was no significant difference in performance between the two groups according to the conversation participation index and in the discontinuance rate assessed with the conversational breakdown index. However, patients with RHD showed a lower topic maintenance rate and higher topic initiation and topic switching rates, according to the topic manipulation index. Therefore, we explored the characteristics of impaired conversation abilities in patients with RHD by assessing their ability to converse and manage topics during structured conversations, and found difficulties with pragmatics and communication discourse in these patients.

How is right hemisphere communication disorder disabling? Evidence from response mobilizing actions in conversation

Aim: Assessment and intervention strategies for communication disorders caused by right hemisphere stroke are at an early stage of development. There is also little evidence on how right hemisphere communication disorder is disabling for everyday life. This study explores how a woman with conversational problems following right hemisphere stroke participated in everyday conversation with family members.Method: One hour of triadic conversation was recorded and analyzed using the descriptive qualitative methodology of conversation analysis. It focused on attempts by the woman with right hemisphere stroke to direct conversation with "response mobilizing" communicative acts, i.e., communicative acts that set out clear expectations about who should speak, and how they should respond.Results: Seventy-eight communicative acts produced by the woman with right hemisphere communication disorder were divided into five groupings based on how her conversation partners addressed them. Around half of her response mobilizing communicative acts received unsupportive responses from her conversation partners, including minimal acknowledgements, explicit rejections, and ignoring responses.Conclusion: The findings of this study provide novel insight into the ways that right hemisphere communication disorder affects routine communication, and the nature of the disability it causes. This information will support the future development of evidence-based speech pathology assessment and intervention for right hemisphere stroke.IMPLICATIONS FOR REHABILITATIONRight hemisphere stroke can have complex implications for communication, but little is known about how they manifest in daily life.Familiar communication partners may deal with troublesome communicative acts in conversation by preventing them from developing, which may be useful information for speech pathology assessment.Speech pathologists should consider sampling everyday conversation because it can provide insight into the ways that communication disorders caused by right hemisphere stroke restrict participation in daily life.