Story arrangement ability in right brain-damaged patients.

The purpose of the present study is to explore the role of an explicit expression of macrostructure in facilitating performance on a Story Arrangement Task. Subjects were presented with a series of sentences which they were required to arrange into a coherent paragraph. Half of the items were preceded by a theme sentence containing the framework or macrostructure of the paragraph, while the items without theme sentences required subjects to formulate their own macrostructure in a bottom-up fashion. Results of the study support the hypothesis that the presence of a theme sentence facilitates performance on the Story Arrangement Task for non-brain-damaged individuals (NBDs) and left brain-damaged patients (LBDs), but not for right brain-damaged patients (RBDs). This suggests that RBDs are impaired in their ability to recognize and benefit from explicit thematic statements in narratives. Other discourse-level deficits in RBDs are discussed in the light of these findings. The performance of LBDs on such tasks is also discussed.     

Temporal parameters as cues to phrasal boundaries: a comparison of processing by left- and right-hemisphere brain-damaged individuals

Two experiments were conducted to examine the ability of left- (LHD) and right-hemisphere-damaged (RHD) patients and normal controls to use temporal cues in rendering phrase grouping decisions. The phrase "pink and black and green" was manipulated to signal a boundary after "pink" or after "black" by altering pre-boundary word durations and pause durations at the boundary in a stepwise fashion. Stimuli were presented to listeners auditorily along with a card with three alternative groupings of colored squares from which to select the presented alternative. Results revealed that normal controls were able to use both temporal cues to identify the intended grouping. In contrast, LHD patients required longer than normal pause durations to consistently identify the intended grouping, suggesting a higher than normal threshold for perception of temporal prosodic cues. Surprisingly, the RHD patients exhibited great difficulty with the task, perhaps due to the limited acoustic cues available in the stimuli.     

Visuospatial processing and the right-hemisphere interpreter

Popular views of hemispheric asymmetry hold that the left hemisphere is specialized for linguistic and cognitive processes and fine motor control, whereas the right is specialized for visuospatial processing. Although this dichotomy contains more than a grain of truth, it is an oversimplification. Experiments with split-brain patients have demonstrated that the left hemisphere retains relatively sophisticated visuospatial abilities, and that the asymmetries that favor the right hemisphere are subtler than those that favor the left. A consideration of the constructive nature of visual perception, and the organization of the visual system in the two hemispheres suggests that asymmetries are likely to arise relatively late in visual processing in areas that represent both sides of visual space. I present evidence in favor of the view that the right hemisphere can be considered more "visually intelligent" than the left, and postulate the existence of a "right-hemisphere interpreter" dedicated to constructing a representation of the visual world.     

Visual-spatial processing in deaf brain-damaged signers

Sign language displays all the complex linguistic structure found in spoken languages, but conveys its syntax in large part by manipulating spatial relations. This study investigated whether deaf signers who rely on a visual-spatial language nonetheless show a principled cortical separation for language and nonlanguage visual-spatial functioning. Four unilaterally brain-damaged deaf signers, fluent in American Sign Language (ASL) before their strokes, served as subjects. Three had damage to the left hemisphere and one had damage to the right hemisphere. They were administered selected tests of nonlanguage visual-spatial processing. The pattern of performance of the four patients across this series of tests suggests that deaf signers show hemispheric specialization for nonlanguage visual-spatial processing that is similar to hearing speaking individuals. The patients with damage to the left hemisphere, in general, appropriately processed visual-spatial relationships, whereas, in contrast, the patient with damage to the right hemisphere showed consistent and severe visual-spatial impairment. The language behavior of these patients was much the opposite, however. Indeed, the most striking separation between linguistic and nonlanguage visual-spatial functions occurred in the left-hemisphere patient who was most severely aphasic for sign language. Her signing was grossly impaired, yet her visual-spatial capacities across the series of tests were surprisingly normal. These data suggest that the two cerebral hemispheres of congenitally deaf signers can develop separate functional specialization for nonlanguage visual-spatial processing and for language processing, even though sign language is conveyed in large part via visual-spatial manipulation.     

Inference deficits in right brain-damaged patients

The inferential reasoning ability of right hemisphere-damaged (RHD) patients was tested by presenting pairs of sentences which were to be treated as single, integrated units. The two sentences treated together made one interpretation likely (a correct inference); one of the sentences in isolation encouraged a different interpretation (an incorrect inference). The position of the misleading sentence was systematically varied. Results showed that, in contrast to normal controls, RHD patients have more trouble answering inference questions, especially those concerning incorrect inferences, than answering questions about the factual content of the passages. Also, RHD patients made significantly more errors when the misleading information was contained in the first rather than in the second sentence; this finding indicates that these patients have difficulty revising previously acquired knowledge in light of new information. These results suggest the impairment of several components of normal discourse processing subsequent to right hemisphere brain damage.     

Stimulus categorization by brain-damaged patients

Patients with localized insult to the right hemisphere, or to either the anterior or the posterior portion of the left hemisphere, as well as neurologically intact controls, evaluated stimuli on a seven-point rating scale for their degree of category membership. The stimuli were taken from one of two continua, one composed of fruit and vegetable items, and the other of items differing in hue and shape. Different subsets of stimuli provided different contexts for the judgments of category membership. The two left-hemisphere groups showed anomalies in categorizing the fruit and vegetable items but not the perceptual items, while the reverse was true for the right-hemisphere patients. Moreover, both left-hemisphere groups demonstrated context effects in their judgments of the representativeness of the fruit and vegetable items, but differed in the way in which they responded to changing contexts. Left posterior patients demonstrated weak category boundaries and even reclassified items. In contrast, patients with left anterior damage showed highly categorical responses and less differentiation of items within a category. All groups showed striking context effects in judgments of perceptual items in terms of changes in representativeness ratings and the location of a category boundary. Alternative interpretations of the results are offered.     

Dissociative tendencies and right-hemisphere processing load: effects on vigilance performance

The present study was designed to explore the relationship between self-reported dissociative experiences and performance in tasks eliciting right-hemisphere processing load. Thirty-four participants (10 men and 24 women) performed a vigilance task in two conditions: with task-irrelevant negative-arousing pictures and task-irrelevant neutral pictures. Dissociation was assessed with the Dissociative Experience Scale. Consistent with theories positing right-hemisphere deregulation in high non-clinical dissociators, dissociative experiences correlated with greater vigilance decrement only in the negative picture condition. As both the vigilance task and negative picture processing are right lateralized, this result provides support for a right-hemisphere dysfunction in high dissociators, at least in negative conditions.     

Auditory processing of brain-damaged adults under competitive listening conditions

Right CVAs, mild left CVAs, and non-brain-damaged adults received the Token Test under three conditions: quiet, white noise, and speech babble. Left CVAs performed most poorly of all groups in all conditions experiencing difficulty with subtests III, IV, and V. Right CVAs were inferior to controls on each of these three subtests in the speech babble condition only. Thus, right CVA difficulty with both memory and syntactic tasks was demonstrated in speech babble. These results are explained by the hypothesis that both hemispheres are necessary to process auditory information under complex listening conditions. Total brain capacity of right CVA patients may be overloaded if either memory load or linguistic complexity is increased in the presence of certain types of listening competition.     

Persisting apraxia in two left-handed, aphasic patients with right-hemisphere lesions

Apraxia usually follows a left hemisphere lesion in right-handers with left hemisphere speech representation. Apraxia following a right hemisphere lesion in left-handers is rare, however, and not well documented in the literature. Two left-handed patients are described in whom apraxia and aphasia followed a right hemisphere lesion. Both the apraxic and the aphasic deficits improved but were still demonstrable 6 weeks following the infarct. The data are consistent with those for right-handers with left hemisphere lesions in suggesting some overlap of anatomical structures for the control of speech and praxis.     

Surprise but not coherence: Sensitivity to verbal humor in right-hemisphere patients

Verbal humor deficits were investigated in right-hemisphere-damaged patients. It was hypothesized that the appreciation of jokes presupposes two elements: sensitivity to the surprise element entailed in the punch line of a joke and apprehension of the coherence which results when the punch line has been integrated with the body of the joke. The possible dissociation between these elements was tested by asking subjects to select from four alternatives the appropriate ending to a joke. Right-hemisphere patients exhibited a selective attraction to endings which contained an element of surprise but which were not otherwise coherent with the body of the joke. This finding suggests that right-hemisphere patients have difficulty in integrating content across parts of a narrative and confirms the psychological reality of the proposed distinction between the surprise and coherence elements of humor processing.     

The analysis of drawing from memory performance in brain-damaged patients

The drawing from memory task is frequently used in cognitive neuropsychology to investigate visual processing impairments. However, in surprising contrast to most other neuropsychological tests, the analyses of results on this task are most often based solely on qualitative judgements about the normality of a patient's performance. In most case reports, these judgements are not made with reference to normative data and are not made by individuals who are impartial with respect to the study (that is, using a blind rating procedure). There are several grounds for arguing that such analyses are inadequate. First, seemingly abnormal drawings made by a patient may well be within the range of performance shown by control subjects. Second, judgments that are not based on a blind rating procedure are likely to be influenced by knowledge about the patient's performance on other tasks. We describe an alternative assessment procedure that addresses both of these concerns.     

Semantic disorders of auditory language comprehension in right brain-damaged patients

A test of auditory language comprehension was given to 110 right brain-damaged patients and to 94 normal controls in order to check if patients with lesions of the right (nondominant) hemisphere make a significantly higher number of semantic errors than normals. Confirmation of the hypothesis was obtained, but the relationship between semantic errors and lesion of the right hemisphere did not seem a simple and direct one. In fact, most of the lexical-semantic errors were due to associated variables (such as unilateral spatial agnosia and general mental deterioration) and not to the lesion of the right hemisphere per se. These data do not suggest a specific semantic capacity of the nondominant hemisphere but rather stress the fragility of the lexical-semantic organization at the cortical level.This work was assisted by a grant from C.N.R. (Consiglio Nazionale delle Ricerche).     

Comprehension of familiar phrases by left- but not by right-hemisphere damaged patients

Single words, familiar phrases (idioms and speech formulas), and novel sentences (matched to the familiar phrases in length, frequency, and structure) were selected for a picture-matching auditory comprehension task and administered to left- and right-brain damaged (LBD, RBD) subjects. The groups did not differ in single word comprehension. A 2 x 2 ANOVA revealed opposite patterns on the two other tasks, with LBD subjects performing worse on novel than familiar phrases, and RBD subject impaired on familiar phrase but not on novel sentence comprehension. The role of grammatical/referential vs. holistic/inferential meaning in left and right hemisphere function is discussed.     

Characteristics of recovery of drawing ability in left and right brain-damaged patients

Drawings of a "person" were obtained from 21 patients with left brain damage (LBD) and 13 patients with right brain damage (RBD) at hospital discharge and 1 month postdischarge, corresponding to 2-4 and 6-8 weeks postonset, respectively. Early LBD drawings were simplistic and often incoherent. Most were placed in the upper left quadrant of the page. RBD drawings were scattered, fragmented, and elaborately detailed. Many showed evidence of left-sided neglect. The resolution of drawing disability also differed between the two groups: LBD subjects recovered drawing abilities more rapidly and more completely than RBD subjects. These differences in drawing characteristics and in the resolution of drawing disability were discernable for experienced neuropsychologists.     

No impairment in sign language after right-hemisphere stroke

A 52-year-old right-handed woman who became deaf before the development of speech, suffered an occlusion of the right middle cerebral and a marked stenosis of the right anterior cerebral arteries. She showed no disturbance in the manual sign language or in finger-spelling, in contrast to previous reports of cases with left-sided damage.