Connie A. Tompkins

A longitudinal study of the psychosocial impact of stroke on primary support persons.

We investigated longitudinally the effects of a stroke on the social support systems and well-being of the patients primary support person, both acutely and as the condition stabilized. Individuals who had suffered a first stroke and a primary support person participated in two waves of data collection, carried out in 6-month intervals beginning 7 weeks after the stroke. Our data show that the prevalence of depressive symptoms is from 2 1/2 to 3 1/2 times higher than rates found among representative samples of middle-aged and elderly populations. Mean level of depression did not change over time, although level of optimism declined significantly. Multiple regression analyses showed that levels of depression and perceived burden in support persons are highly related to aspects of the stroke such as its severity, and that demographic variables such as age and income play a relatively minor role in attenuating these relations in the acute adjustment phase. However, from 7 to 9 months after the stroke, well-established demographic variables such as health, income, and age were significant predictors of depression. Individuals who were older and who had good health and higher incomes were least depressed.

Right hemisphere appreciation of prosodic and linguistic indications of implicit attitude.

Appreciation of attitudes conveyed through prosodic cues and lexical content was examined in subjects with temporal lobe seizure foci. One task involved auditory judgments of the consistency of verbal and intonational meaning of sentences. Errors on judgments of consistent verbal and prosodic stimuli were not only more frequent in the right temporal group than in left temporals or controls but were strongly related to neuropsychological indices associated with extent of right temporal involvement. Answering questions based on written narratives in which multiple attitude markers were either redundant or conflicting comprised the second task. Right temporal patients as a group had difficulty in answering inferential questions about paragraphs with inconsistent indicators of attitude. Even low-scoring right temporals were able, however, to answer inferential and factual questions when the verbal context markers consistently reinforced a particular attitude.

Assessment of depression in patients with brain pathology : The case of stroke

The assessment of depression in patients with brain pathologies--a topic of considerable clinical and research interest--is complicated by a variety of factors. Among the most problematic are cognitive consequences of brain injury that can diminish the reliability and validity of information used to diagnose depression, determine its severity, ascertain its predictors, and evaluate its impact. In this article, the authors examine the challenges to depression assessment in patients who have had a stroke, the neurologically impaired population in which it has been most frequently studied. Focusing on poststroke depression research, they describe methodological limitations that may contribute to conflicting outcomes and conclusions and offer suggestions for improving the specificity, consistency, validity, and reliability of assessment methods and procedures when investigating depression in patients with brain pathologies.

Predicting cognitive recovery from closed head-injury in children and adolescents

Longitudinal data from 84 head-injured children and adolescents, who were tested at three points in the first year postinjury, were analyzed to determine the best combination of demographic, injury-related, and behavioral factors predicting cognitive performance. Dependent variables were language, memory, visuomotor, and speeded performance factor scores obtained through confirmatory factor analyses of an extensive test battery. Multiple regression analyses indicated that injury severity and the existence of previous psychological, physical, or cognitive disorders were primary for predicting acute (1 month post-hospital discharge) performance for older subjects. For younger subjects, however, parental marital status was the most important correlate of acute cognitive performance. Those residing in homes with both parents fared better than children in one-parent families. At 6 months and 1 year postinjury, the older subjects who performed most poorly initially remained the most impaired. For younger children, acute cognitive standing was also an important predictor of later performance, but parental marital status remained a crucial influence on their longer-term recovery of cognitive skills.

Suppression and discourse comprehension in right brain-damaged adults: A preliminary report

Abstract Eighteen right-hemisphere-damaged (RHD) and 15 control subjects listened to sentences that ended in lexical ambiguities. The sentence verbs biased ambiguity interpretation. Probe words, representing unbiased meanings of the ambiguities, were presented for rapid judgements of their fit with the sentences. In rejecting probe words, both groups showed interference from unbiased meanings of the ambiguities at a short (175 ms) probe interval. Only RHD adults demonstrated interference 1000 ms after sentence offset, indicating that they suppressed contextually inappropriate meanings less effectively than control subjects. Discourse comprehension performance in RHD adults was also correlated with suppression. Theoretical and clinical implications are considered.

Reliability and validity of an auditory working memory measure: data from elderly and right-hemisphere damaged adults

The use of non-standardized measures in research and clinical assessments creates difficulties with interpretation and generalization of results obtained. One example of a widely used non-standardized tool is the reading/listening span paradigm for assessment of working memory (WM). WM is an important construct because of its purported relationship to language comprehension and capacity theories of cognition. This paper investigates several facets of reliability and validity for an auditory working memory measure designed for older adults and individuals with right hemisphere brain damage (RHD). Results from 28 non-brain-damaged subjects (NBD) and 11 RHD subjects indicate that the measure is internally consistent and reliable over time. Construct validity evidence, which compares favourably with evidence from existing literature, suggests that for NBD subjects this tool differentiates WR I from simple short term memory. RHD subjects do not demonstrate the same pattern of validity results as the NBD group. Further evaluation with RHD patients is warranted, because clinically this tool may be useful as a measure of severity or a prognostic indicator of language comprehension abilities for this population.

Coarse coding and discourse comprehension in adults with right hemisphere brain damage

Background: Various investigators suggest that some discourse‐level comprehension difficulties in adults with right hemisphere brain damage (RHD) have a lexical‐semantic basis. As words are processed, the intact right hemisphere arouses and sustains activation of a wide‐ranging network of secondary or peripheral meanings and features—a phenomenon dubbed “coarse coding”. Coarse coding impairment has been postulated to underpin some prototypical RHD comprehension deficits, such as difficulties with nonliteral language interpretation, discourse integration, some kinds of inference generation, and recovery when a reinterpretation is needed. To date, however, no studies have addressed the hypothesised link between coarse coding deficit and discourse comprehension in RHD. Aims: The current investigation examined whether coarse coding was related to performance on two measures of narrative comprehension in adults with RHD. Methods & Procedures: Participants were 32 adults with unilateral RHD from cerebrovascular accident, and 38 adults without brain damage. Coarse coding was operationalised as poor activation of peripheral/weakly related semantic features of words. For the coarse coding assessment, participants listened to spoken sentences that ended in a concrete noun. Each sentence was followed by a spoken target phoneme string. Targets were subordinate semantic features of the sentence‐final nouns that were incompatible with their dominant mental representations (e.g., “rotten” for apple). Targets were presented at two post‐noun intervals. A lexical decision task was used to gauge both early activation and maintenance of activation of these weakly related semantic features. One of the narrative tasks assessed comprehension of implied main ideas and details, while the other indexed high‐level inferencing and integration. Both comprehension tasks were presented auditorily. For all tasks, accuracy of performance was the dependent measure. Correlations were computed within the RHD group between both the early and late coarse coding measures and the two discourse measures. Additionally, ANCOVA and independent t‐tests were used to compare both early and sustained coarse coding in subgroups of good and poor RHD comprehenders. Outcomes & Results: The group with RHD was less accurate than the control group on all measures. The finding of coarse coding impairment (difficulty activating/sustaining activation of a words peripheral features) may appear to contradict prior evidence of RHD suppression deficit (prolonged activation for context‐inappropriate meanings of words). However, the sentence contexts in this study were unbiased and thus did not provide an appropriate test of suppression function. Correlations between coarse coding and the discourse measures were small and nonsignificant. There were no differences in coarse coding between RHD comprehension subgroups on the high‐level inferencing task. There was also no distinction in early coarse coding for subgroups based on comprehension of implied main ideas and details. But for these same subgroups, there was a difference in sustained coarse coding. Poorer RHD comprehenders of implied information from discourse were also poorer at maintaining activation for semantically distant features of concrete nouns. Conclusions: This study provides evidence of a variant of the postulated link between coarse coding and discourse comprehension in RHD. Specifically, adults with RHD who were particularly poor at sustaining activation for peripheral semantic features of nouns were also relatively poor comprehenders of implied information from narratives.

Rehabilitation for Cognitive-Communication Disorders in Right Hemisphere Brain Damage

Although the left hemisphere of the brain has long been linked with language, the right cerebral hemisphere also contributes importantly to cognitive operations that underlie language processing and communicative performance. Adults with right hemisphere damage (RHD) typically do not have aphasia, but they often have communication disorders that may have a substantial impact on their social functioning. After a brief summary of communicative and cognitive characteristics of RHD in adults and of extant theoretical accounts of common communicative difficulties, this article discusses rehabilitation issues, approaches, evidence, and needs.

A different story on “Theory of Mind” deficit in adults with right hemisphere brain damage

Background: Difficulties in social cognition and interaction can characterise adults with unilateral right hemisphere brain damage (RHD). Some pertinent evidence involves their apparently poor reasoning from a “Theory of Mind” perspective, which requires a capacity to attribute thoughts, beliefs, and intentions in order to understand other peoples behaviour. Theory of Mind is typically assessed with tasks that induce conflicting mental representations. Prior research with a commonly used text task reported that adults with RHD were less accurate in drawing causal inferences about mental states than at making non‐mental‐state causal inferences from control texts. However, the Theory of Mind and control texts differed in the number and nature of competing discourse entity representations. This stimulus discrepancy, together with the explicit measure of causal inferencing, likely put the adults with RHD at a disadvantage on the Theory of Mind texts. This project was supported in part by grant # DC01820 from the National Institute on Deafness and Other Communicative Disorders. The authors are indebted to Denise Balason, Meghan Capellini, Bethany Peters, Anita Lewis, Sara Byers, and Annie Palaika for their assistance. Aims: This study revisited the question of Theory of Mind deficit in adults with RHD. The aforementioned Theory of Mind texts were used but new control texts were written to address stimulus discrepancies, and causal inferencing was assessed relatively implicitly. Adults with RHD were hypothesised not to display a Theory of Mind deficit under these conditions. Methods & Procedures: The participants were 22 adults with unilateral RHD from cerebrovascular accident, and 38 adults without brain damage. Participants listened to spoken texts that targeted either mental‐state or non‐mental‐state causal inferences. Each text was followed by spoken True/False probe sentences, to gauge target inference comprehension. Both accuracy and RT data were recorded. Data were analysed with mixed, two‐way Analyses of Variance (Group by Text Type). Outcomes & Results: There was a main effect of Text Type in both accuracy and RT analyses, with a performance advantage for the Theory of Mind/mental‐state inference stimuli. The control group was faster at responding, and primed more for the target inferences, than the RHD group. The overall advantage for Theory of Mind texts was traceable to one highly conventional inference: someone tells a white lie to be polite. Particularly poor performance in mental‐state causal inferencing was not related to neglect or lesion site for the group with RHD. Conclusions: With appropriate stimulus controls and a relatively implicit measure of causal inferencing, this study found no “Theory of Mind” deficit for adults with RHD. The utility of the “Theory of Mind” construct is questioned. A better understanding of the social communication difficulties of adults with RHD will enhance clinical management in the future.

Inferencing in adults with right hemisphere brain damage: An analysis of conflicting results

Recent proposals have suggested that inferencing deficits may underlie many cognitive-communicative disorders following right hemisphere brain damage (RHD). However, there is conflicting evidence for these claims. The current review details two major factors that may contribute to the inconsistent findings. First, RHD inferencing studies do not take into consideration models of normal inferencing processes. Such frameworks suggest that inference generation may be modulated by inference type, stimulus characteristics, and the task used to measure inferencing. Few of these factors have been considered in the RHD literature. As a result, conclusions and interpretations may not accurately reflect the state of inferencing abilities after RHD. Predicting and evaluating results also are problematic without a guiding framework. The difficulties encountered in dealing with a heterogeneous population create a second source of inconsistent results. Common sampling biases contribute to inaccurate interpretations of RHD inferencing. Suggestions are provided for dealing with group heterogeneity and issues of generalizability.