Clinical neurologic aspects of the right-hemisphere deficit syndrome

Aprosodia and prosoplegia with right frontal neurodegeneration

Affective prosody and facial expression are essential components of human communication. Aprosodic syndromes are associated with focal right cerebral lesions that impair the affective-prosodic aspects of language, but are rarely identified because affective prosody is not routinely assessed by clinicians. Inability to produce emotional faces (affective prosoplegia) is a related and important aspect of affective communication has overlapping neuroanatomic substrates with affective prosody. We describe a patient with progressive aprosodia and prosoplegia who had right greater than left perisylvian and temporal atrophy with an anterior predominance. We discuss the importance of assessing affective prosody and facial expression to arrive at an accurate clinical diagnosis.

Acute Ischemic Lesions Associated with Impairments in Expression and Recognition of Affective Prosody

PURPOSE

We aimed to: (a) review existing data on the neural basis of affective prosody;(b) test the hypothesis that there are double dissociations in impairments of expression and recognition of affective prosody; and (c) identify areas of infarct associated with impaired expression and/or recognition of affective prosody after acute right hemisphere (RH) ischemic stroke.

METHODS

Participants were tested on recognition of emotional prosody in content-neutral sentences. Expression was evaluated by measuring variability in fundamental frequency. Voxel-based symptom mapping was used to identify areas associated with severity of expressive deficits.

RESULTS

We found that 9/23 patients had expressive prosody impairments; 5/9 of these patients also had impaired recognition of affective prosody; 2/9 had selective deficits in expressive prosody; recognition was not tested in 2/9. Another 6/23 patients had selective impairment in recognition of affective prosody. Severity of expressive deficits was associated with lesions in right temporal pole; patients with temporal pole lesions had deficits in expression and recognition.

CONCLUSIONS

Expression and recognition of prosody can be selectively impaired. Damage to right anterior temporal pole is associated with impairment of both, indicating a role of this structure in a mechanism shared by expression and production of affective prosody.

Neuropsychological differences among children with Asperger syndrome, nonverbal learning disabilities, attention deficit disorder, and controls

Confusion is present as to possible diagnostic differences between Asperger syndrome (AS) and Nonverbal learning disabilities (NLD) and the relation of these disorders to attentional difficulties. Three-hundred and forty-five children participated in this study in 5 groups; NLD, AS, attention deficit hyperactivity disorder (ADHD): Combined type, ADHD: Inattentive type, and controls. The NLD group showed particular difficulty on visual-spatial, visual-motor, and fluid reasoning measures compared to the other groups. There was also a significant verbal-performance IQ split in this group related to difficulty in social functioning. This study extends the findings from previous studies and extends these findings to differences between AS and NLD groups.

The relation of humor and child development: social, adaptive, and emotional aspects

A sense of humor has been linked to social competence, popularity, and adaptability. The purpose of this review was to investigate the extant research in humor in childhood. Emerging work on the neuroanatomy of humor was discussed with findings of right hemispheric involvement for the comprehension and appreciation of humor for the affective network and the left hemisphere for cognitive understanding. These findings are intriguing when examining humor functioning in children with various disabilities, particularly the right hemisphere for children with autistic spectrum disorders or nonverbal learning disabilities. Examination of research in humor in childhood disabilities found most articles on humor in children with autistic spectrum disorder or mental retardation, with few to none in learning disabilities or attention deficit hyperactivity disorder. It was concluded that further study is needed to understand humor in children with disabilities and that such understanding will assist with interventions.

Cerebral localization of functions and the neurology of language: fact versus fiction or is it something else?

Over the last 15 years there has been a burgeoning number of publications using functional brain imaging (>40,000 articles based on an ISI/Web of Science search) to localize behavioral and cognitive processes to specific areas in the human brain that are often not confirmed by traditional, lesion-based studies. Thus, there is a need to reassess what cerebral localization of functions is and is not. Otherwise, there is no rational way to interpret the escalating claims of localization in the functional imaging literature that is taking on the appearance of neurophysiologic "phrenology". This article will present arguments to suggest that functional localization in the brain is a robust but very dynamic, four-dimensional process. It is a learned phenomenon driven over time by large-scale, spatially distributed, neural networks seeking to efficiently maximize the processing, storage, and manipulation of information for cognitive and behavioral operations. Because of historical considerations and space limitations, the main focus will be on localization of language-related functions whose theoretical neurological basis can be generalized for any complex cognitive-behavioral function.

Comprehension of humor in children with nonverbal learning disabilities, reading disabilities, and without learning disabilities

The normal development of humor in children has been well documented with a predictable course that is tied to social, cognitive, and linguistic development in children. This study explored humor comprehension in children with nonverbal learning disabilities (NVLD). Children with NVLD were compared with children with reading disabilities and a comparison group of children with no learning disabilities to assess their comprehension of humor. The humor test was composed of a joke and cartoon section. No group differences in humor comprehension were found when the NVLD group was defined as having visual-spatial and visual reasoning deficits. However, when the NVLD group was divided into children with and without social perceptual difficulties as defined by a direct measure of social comprehension, significant group differences were found in the levels of humor comprehension. These results support the association of humor comprehension with social perception and lend tentative support to the hypothesis that children with NVLD may not be a homogenous group. Future study directions include further exploration into the nature of the association between humor comprehension and social perception as well as closer examination of the heterogeneity of NVLD.

Nonverbal learning disability: a tutorial for speech-language pathologists

Nonverbal learning disability (NLD) is a diagnostic category that is unfamiliar to most speech-language pathologists. This brief tutorial describes NLD's characteristics, a theoretical model proposed to explain its source, and areas of overlap between NLD and similar diagnostic categories. The communicative profile, made up of difficulties in pragmatic and semantic language in the presence of relatively preserved syntactic skill, is also discussed. Empirical evidence relevant to NLD is also evaluated. Many questions remain unresolved, but until systematic research provides definitive answers, speech-language pathologists are encouraged to rely on careful description of the individual child's communicative strengths and weaknesses to identify appropriate targets and to focus intervention on improving the child's ability to communicate effectively in everyday contexts.

Hemispheric function in disorganized type schizophrenia: performance on the quality extinction test

We assessed hemisphere function in right-handed male chronic, disorganized type schizophrenic patients (N = 60, age range 18-45 years) using the Quality Extinction Test (QET), in comparison to 20 right-handed male healthy controls in the same age range. The QET analysis discriminated between the disorganized schizophrenic patients and the controls. QET results indicated that chronic schizophrenic patients were less sensitive to tactile stimuli in both hands as compared to controls. Furthermore, the sensitivity to tactile stimuli of the left hand was less than that of the right hand in the schizophrenic patients. In contrast, in the normal controls the sensitivity was similar in both hands. These results indicate possible right hemisphere dysfunction together with disturbance in interhemispheric transmission through the corpus callosum in chronic, disorganized type schizophrenic patients.

Spatial and emotional aspects of language inferencing in nonverbal learning disabilities

Although subtle linguistic deficits have been postulated for children identified with nonverbal learning disabilities (NLD), there is little empirical evidence to support this contention. Two experimental language inferencing measures that have been demonstrated to be problematic for individuals with right hemisphere brain damage (RHBD) and one norm-referenced inferencing task were examined in three groups of children aged 9-13: (1) children with NLD (n = 14), (2) children with verbal impairments (VI) (n = 14), and (3) children without learning disabilities who served as controls (n = 19). The NLD and VI groups did not differ from one another on any of the three measures, indicating a generalized language inferencing deficit in the NLD group. Relative to the control group, however, the NLD group experienced specific difficulties with spatial and emotional inferencing. The implications for right hemisphere involvement in the NLD profile are examined in relation to the effects of working memory on inferential abilities.

Attention-deficit hyperactivity disorder and developmental right-hemisphere syndrome: congruence and incongruence of cognitive and behavioral aspects of attention

We studied clinical aspects of attention in three groups: children with developmental right-hemisphere syndrome and attention-deficit hyperactivity disorder (ADHD), children with ADHD only, and normal controls. The three groups (N = 54) were case-matched for age, sex, IQ, hand dominance, and socioeconomic status. ADHD was diagnosed clinically using the Diagnostic and Statistical Manual of Mental Disorders-III-Revised criteria and the Conners' Abbreviated Teacher Questionnaire. Additional aspects of attention and behavior were measured by the Child Behavior Checklist, a low-cognitive-load continuous performance task, and the visual target cancellation test (paper and pencil). Although the Child Behavior Checklist profile of attentional deficits in the two clinical groups was similar, we found that the developmental right-hemisphere syndrome group was more severely impaired on parameters of attention measured by the continuous performance task and visual target cancellation test than the children with ADHD. We conclude that the profile of attentional deficits in developmental right-hemisphere syndrome is different than that seen in children with ADHD only, possibly reflecting disparate neurologic underpinnings for the two syndromes.

Intellectual status of children with cerebral palsy after elementary education

Using Wechsler Intelligence Tests, we compared the intellectual status of children with cerebral palsy (CP) immediately before and 2 years after entering school. Verbal and performance IQs could be assessed for 23 children with spastic diplegia but only verbal IQs in six children with spastic quadriplegia. Performance IQs were much lower than verbal IQs in both the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) and the Wechsler Intelligence Scale for Children-Revised (WISC-R) in children with spastic diplegia. After schooling, verbal IQ was significantly increased but there was no change in performance IQ, thus, the difference between these IQs became more pronounced. When comparing the school class types, the verbal IQs of children studying in ordinary classes became statistically higher than those of children in special classes. In contrast, since the increases in mean performance IQs were greater in children in special classes, the differences between these IQs became more pronounced in children studying in ordinary classes. We also found that although verbal IQs were lower for quadriplegic children than for diplegic children at preschool age, there was no difference after 2 years of schooling. These results underline the importance and benefits of appropriate education for children with CP.

Psychological aspects of von Recklinghausen neurofibromatosis (NF1)

Neurofibromatosis is a devasting autosomal dominant disease which is extremely variable in its symptomatology, intensity, and progression. There have been numerous reports published about the physical aspects of neurofibromatosis, while psychological issues have been given little attention so far. The present article presents a review of the current knowledge concerning psychological aspects of neurofibromatosis. Information is provided relating to physical appearance, intellectual impairment, neuropsychological findings, learning disability, and psychiatric disorders.