The effects of right hemisphere damage on the pragmatic interpretation of conversational remarks

The ability to interpret conversational utterances was assessed in a group of 12 male patients with unilateral right hemisphere brain damage (RHD) and 12 non-brain-damaged, age-matched male control subjects. Subjects listened to short vignettes which described both the affective tone of the relationship between a speaker and an actor, and the actor's performance on a task. Each vignette concluded with the speaker characterizing the actor's performance. In half of the items, the speaker's utterance was literally true; in the other half, the utterance was literally false and invited a nonliteral interpretation. Results showed no appreciable differences in the performance of control subjects and RHD patients when interpreting literally true utterances. In contrast, the two groups differed reliably when interpreting the pragmatic intent of nonliteral utterances: Control subjects used information about both the actor's performance and the speaker-actor relationship, while RHD patients demonstrated difficulty in using the information about the speaker-actor relationship. Results have implications for patients' understanding of essential elements of conversations, such as characters' internal states and their intentions in employing different forms of literal and nonliteral language.     

Appreciation of pragmatic interpretations of indirect commands: comparison of right and left hemisphere brain-damaged patients

Indirect commands can elicit "literal" interpretations, directly reflecting the content and form of the utterance, or "pragmatic" interpretations, incorporating knowledge of paralinguistic, social, or historical cues. The aim of this study was to demonstrate how right brain-damaged (RBD) subjects would perform on judgments of these forms of communication. It was predicted that relative to normal controls or aphasic subjects, the RBD subjects would have significant difficulty appreciating the pragmatic interpretation relative to the literal one. Subjects judged the appropriateness of two-part exchanges consisting of indirect commands, direct commands, Wh-questions coupled with pragmatic responses, literal responses, responses verifying the physical surround, or syntactically similar responses. The results confirm that the RBD subjects had a selective difficulty appreciating the indirect commands. Their preference of literal over pragmatic interpretations was significantly different to that of aphasics or normal controls. Hypotheses are offered to explain these data.     

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.     

Inference of object use from pantomimed actions by aphasics and patients with right hemisphere lesions

Twenty-four aphasic and fifteen right brain-damaged subjects were compared on their ability to identify the objects whose use was depicted in a series of twenty videotaped pantomimes. Aphasics were inferior to right brain-damaged patients in inferring object use. Success was correlated with Performance IQ, but not with language measures. Analysis of movement features contributing to subjects' choices reveal speed of movement and object weight to be the most robust and hand shape and size to be the most fragile.This study was supported in part by the grants from the National Institute of Health (RO1 EY07861) and McDonnell Pew Foundation (T89-01245-017) to LMV and by the USPHS grant NS06209 to H.G. and L.M.V. The authors are indebted to the staff of the Neuropsychology and Communication Disorders Departments at the New England Rehabilitation Hospital for making available the test records of the patients included in this study. All the patients included in the study have signed the informed consent forms according to the regulations of the Human Subjects Committee at New England Rehabilitation Hospital.     

Comprehension of humorous and nonhumorous materials by left and right brain-damaged patients

Right hemisphere-damaged (RHD) and left hemisphere-damaged (LHD) aphasic patients were tested on a nonverbal cartoon completion task that included a humorous (Joke) and a nonhumorous (Story) condition. In both conditions, RHD patients performed worse than LHD patients. More importantly, the qualitative difference between the errors produced by the two groups suggests that right and left hemisphere brain damage impairs different components of narrative ability. RHD patients showed a preserved sensitivity to the surprise element of humor, and a diminished ability to establish coherence. Conversely, LHD patients, when they erred, showed an impaired sensitivity to the surprise element of humor, and a preserved ability to establish coherence by integrating content across parts of a narrative. These results suggest that the observed humor comprehension deficits of RHD patients result specifically from right hemisphere disease and not from brain damage irrespective of locus. The performances of the RHD and LHD patients groups together support a separation of narrative ability from the traditional aspects of language ability typically disrupted in aphasia.     

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).     

Personal relevance and the human right hemisphere.

Brain damage can selectively disrupt or distort information and ability across the range of human behaviors. One domain that has not been considered as an independent attribute consists of acquisition and maintenance of personal relevant entities such as "familiar" faces, persons, voices, names, linguistic expressions, handwriting, topography, and so on. In experimental studies of normal mentation, personal relevance is revealed in studies of emotion, arousal, affect, preference and familiarity judgments, and memory. Following focal brain damage, deficits and distortions in the experience of personal relevance, as well as in recognizing formerly personally relevant phenomena, are well known to occur. A review and interpretation of these data lead to a proposal that the right hemisphere has a special role in establishing, maintaining, and processing personally relevant aspects of the individual's world.     

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.     

The different types of limb apraxia errors made by patients with left vs. right hemisphere damage

Limb apraxia errors were compared among normal controls and right- or left-hemisphere-damaged patients as they imitated gestures with the ipsilateral hand. Both brain-damaged groups made similar errors on nonrepresentative and representative/intransitive movements. In contrast for pretended object use movements (transitive), the left-hemisphere-damaged group made more arm position and classical body-part-as-object errors while the right hemisphere group made as many partial errors and more less-primitive, body-part-as-object errors than the left-hemisphere-damaged group. These results help explain why a certain percentage of right-hemisphere-damaged patients are labeled apraxic, but also suggest that the left hemisphere is more important for integrating intrapersonal space and the “representation” of extrapersonal space.     

Form-specific visual priming in the right cerebral hemisphere.

Results of 4 experiments indicate that both within-modality and case-specific visual priming for words are greater when test stimuli are presented initially to the right cerebral hemisphere (RH). In contrast, neither within-modality nor case-specific explicit memory for words is greater when stimuli are presented initially to the RH. Priming is measured using word-stem completion, and explicit memory is measured using word-stem cued recall. In both cases, Ss first rate how much they like words, and then word stems are presented briefly to the RH (in the left visual field) or to the left hemisphere (in the right visual field). Results suggest that at least 2 separate systems encode the visual representations that produce priming. The system that is more effective in the RH is better at representing form-specific information, whereas another system that is not more effective in the RH does not distinguish among distinct instances of word forms.     

Perception of vocal effort and distance from the speaker on the basis of vowel utterances

The sound pressure level of vowels reflects several nonlinguistic and linguistic factors: distance from the speaker, vocal effort, and vowel quality. Increased vocal effort also involves the emphasis of higher frequency components and increases in F0 and F1. This should allow listeners to distinguish it from decreased distance, which does not have these additional effects. It is shown that listeners succeed in doing so on the basis of single vowels if phonated, but not if whispered, and that they compensate for most of the between-vowel variation in level. The results obtained when listeners had to estimate vocal effort as well as distance suggest that an analysis of an utterance takes place at an early stage in auditory processing, before memories of episodes are stored.     

Imagery and verbal encoding in left and right hemisphere damaged patients

Neuropsychological aspects of imaginal and verbal encoding in memory were explored in two forced-choice recognition memory experiments with patients suffering from left and right anterior cerebral hemisphere damage. In the first experiment stimulus type and rate of presentation were varied. Predictions of patient performance based on the hypothesis that left anterior hemisphere pathology impairs verbal memory coding and right anterior hemisphere pathology impairs imaginal coding were confirmed. In a second recognition memory experiment for pictures of common objects, system-specific (imaginal or verbal) interference and distractor effects were demonstrated by analyzing the effects of interpolated tasks and the nature of false-recognition errors.     

The role of the right hemisphere in speech act comprehension

In this research the role of the RH in the comprehension of speech acts (or illocutionary force) was examined. Two split-screen experiments were conducted in which participants made lexical decisions for lateralized targets after reading a brief conversation remark. On one-half of the trials the target word named the speech act performed with the preceding conversation remark; on the remaining trials the target did not name the speech act that the remark performed. In both experiments, lexical decisions were facilitated for targets representing the speech act performed with the prior utterance, but only when the target was presented to the left visual field (and hence initially processed by the RH) and not when presented to the right visual field. This effect occurred at both short (Experiment 1: 250 ms) and long (Experiment 2: 1000 ms) delays. The results demonstrate the critical role played by the RH in conversation processing.     

The role of the right hemisphere in the production of linguistic stress

Recent research has proposed a general prosodic disturbance associated with right hemisphere damage (RHD), one encompassing both affective and linguistic functions. The present study attempted to explore whether the ability to produce linguistic prosody was impaired in this patient population. Productions of phonemic stress tokens (e.g., Re'dcoat vs. red coa't) as well as examples of contrastive stress, or sentential emphasis (e.g., Sam hated the movie), were elicited from eight male speakers with unilateral right hemisphere CVAs and seven male control subjects. Two types of analyses were conducted on these utterances. Acoustic analysis focused on the correlates associated with word stress, namely changes in amplitude, duration, and fundamental frequency. The perceptual saliency of emerging cues to stress was also examined by presentation of test tokens to phonetically trained listeners for identification of stress placement. The patients as a group produced fewer acoustic cues to stress compared to the normal subjects, but no statistical differences were found between groups for either stress at the phrase level or at the sentence level. In the perceptual analysis, stress produced by the patient group was judged to be less salient than that for the normal group, although a high degree of variability was evident in both populations. The data suggest a spared processing mechanism for linguistic prosody in RHD speakers, thus mitigating against the view of a general dysprosody tied to RHD.     

On the representation of language in the right hemisphere of right-handed people.

Laterality experiments using reaction time were conducted to assess the performance of the right hemisphere of normal people on verbal tasks. The results show that if the task calls for pictorial encoding of visually presented verbal material, then the right hemisphere's performance is superior to that of the left. When the task calls for linguistic analysis, the minor hemisphere displays no aptitude in dealing with the task. The latter finding is at variance with data from split-brain research. To reconcile these differences, it was proposed that language functions, though represented in the right hemisphere of normal people, are functionally localized in the left. When the control which the left hemisphere exerts over the right is weakened or removed, e.g., by commissurotomy, right hemisphere language is released. The application of this model to other neurological phenomena is briefly discussed.     

Optic aphasia and the right hemisphere: a replication and extension.

Optic aphasia is a rare, visual modality-specific naming disorder. We describe a patient who developed this disorder subsequent to a left occipital lobe infarction. Like another case that we described previously, this patient performed normally on a variety of tasks assessing the recognition of objects he could not name. Additionally, although he never read aloud a single word, his performance on lexical decision and word comprehension tasks was far better than chance. We suggest that his performance was mediated by a right hemisphere semantic system.     

Anomaly detection in the right hemisphere: The influence of visuospatial factors

Previous research with both brain-damaged and neurologically intact populations has demonstrated that the right cerebral hemisphere (RH) is superior to the left cerebral hemisphere (LH) at detecting anomalies (or incongruities) in objects (Ramachandran, 1995; Smith, Tays, Dixon, & Bulman-Fleming, 2002). The current research assesses whether the RH advantage for anomaly detection is due to the RH superiority for visuospatial skills or is a distinct cognitive process. Sixty undergraduate participants completed tasks assessing anomaly detection, mental rotation, and global and local perceptual abilities. The results demonstrate that anomaly detection is negatively correlated with mental rotation. These findings suggest that anomaly detection is not simply a function of visuospatial skills.     

The role of the right hemisphere in the apprehension of complex linguistic materials

To secure information on which aspects of linguistic functioning might be mediated by the nondominant hemisphere, a test battery assessing sensitivity to narrational and humorous materials was administered to a population of right-hemisphere-damaged patients, as well as relevant control groups of normal, aging, and aphasic individuals. While elementary linguistic functioning was adequate, the right-hemisphere-injured groups exhibited consistent difficulties in respecting the boundaries of a fictive entity, assessing the plausibility of elements within a story or joke, selecting the appropriate punch line for a joke, and integrating elements of a story into a coherent narrative. Certain elements—specifically emotional content and noncanonical facts injected into a narrative—also posed characteristic difficulties for these patients. The results suggest that, in contrast to the other populations, right-hemisphere patients exhibit special difficulties in processing complex linguistic entities and in utilizing the surrounding context as they assess linguistic messages.