Ronald L. Bloom

Emotional Processing Deficits in Individuals With Unilateral Brain Damage

This article presents a review of the neural mechanisms underlying emotional processing deficits (EPDs) in individuals with unilateral brain damage. First, key theoretical issues pertaining to the neuropsychology of emotion are presented. These include parameters of emotional processing, the componential approach, emotional domains, and hypotheses regarding hemispheric specialization for emotion. Second, the literature on hemispheric asymmetries for emotion is reviewed in terms of processing mode (perception and expression) and communication channel (facial, prosodic-intonational, and lexical-verbal). Studies involving normal adults and individuals with right- or left-sided brain damage are reviewed. Third, recent findings identifying the role of the right hemisphere in emotional processing are described. The article is concluded by aligning these new data with findings from the general literature, providing added support for the right-hemisphere emotion hypothesis.

Verbal Pragmatics Following Unilateral Stroke: Emotional Content and Valence

Verbal pragmatic aspects of discourse production were examined in 16 right brain-damaged (RBD), 16 left brain-damaged (LBD), and 16 normal control right-handed adults. The facilitation effect of emotional content, valence hypothesis, and relationship between pragmatics and emotion were evaluated. Participants produced monologues while recollecting emotional and nonemotional experiences. Transcribed monologues were rated for appropriateness on 6 pragmatic features: conciseness, lexical selection, quantity, relevancy, specificity, and topic maintenance. Overall, brain-damaged groups were rated as significantly less appropriate than normals. Consistent with the facilitation effect, emotional content enhanced pragmatic performance of LBD aphasic participants yet suppressed performance of RBD participants. Contrary to the valence hypothesis, RBD participants were more impaired for positive emotions and LBD participants for negative emotions. Pragmatic appropriateness was not strongly correlated with a measure of emotional intensity.

Impact of emotional content on discourse production in patients with unilateral brain damage.

A picture story task was developed to examine expression of emotion via the verbal/lexical channel. The task elicited discourse with either emotional, visual-spatial, or neutral content and was administered to right brain-damaged (RBD), left brain-damaged (LBD), and normal control (NC) right-handed adults. Subjects were matched for gender, age, education, and occupational status. The brain-damaged groups were matched for months post-CVA onset and were similar with respect to intrahemispheric site of lesion. While the number of words produced was equivalent for each of the subject groups, the RBDs and LBDs expressed quantitatively less content than did the NCs. When content differences were examined within each subject group, there were no differences for LBDs and NCs, but the RBDs showed a selective deficit when producing emotional content. This finding suggests a special role for the right hemisphere in the production of emotional content in verbal discourse.

A PRELIMINARY CHARACTERIZATION OF LEXICAL EMOTIONAL EXPRESSION IN RIGHT AND LEFT BRAIN-DAMAGED PATIENTS

Disorders in nonverbal communication of emotion have been documented in patients with right hemisphere pathology; lexical expression of emotion is virtually unstudied. In this preliminary investigation, emotionally laden slides were used to elicit discourse from right brain-damaged (RBD), left brain-damaged (LBD), and normal control (NC) subjects. New techniques were developed to examine the ability of these subjects to express emotion in words; formalistic and pragmatic analyses of the discourse were conducted. RBDs, relative to NCs and LBDs, were less successful in using words to convey emotion and produced words of lower emotional intensity. LBD aphasics, despite their linguistic deficits, were comparable to NCs in conveying emotional valence. The data tend to support the speculation that the right hemisphere is dominant for lexical expression of emotion. This study has implications for the neuropsychological investigation of language, emotion, and the brain.

Using voice recognition software to treat dysgraphia in a patient with conduction aphasia

Background: Augmentative and alternative communication (AAC) has primarily been utilised for motor speech deficits or as an aid for communicating basic needs in the acute stages of aphasia rehabilitation. However, AAC strategies can be employed for individuals with aphasia across a wide range of severity levels and at different stages of recovery. For individuals with chronic impairments in language, voice recognition software can further enhance communication by providing an alternative means for written expression. Aims: To investigate the functional and linguistic effects of a treatment program that used voice recognition software to improve written communication in an individual with chronic aphasia. Methods & Procedures: A 65-year-old woman with conduction aphasia participated in a prospective case study. During baseline testing the individual was evaluated on measures of language (i.e., Boston Diagnostic Aphasia Examination, 3rd edition, Goodglass, Kaplan, & Baressi, 2001; Boston Naming Test, Kaplan, Goodglass, & Weintraub, 2001), computer skills, and functional communication (i.e., ASHA FACs, Frattali et al., 1995; Quality of Communication Life Scales, Paul et al., 2004). A cursory examination of the oral peripheral structure was administered. Treatment consisted of 10 one-hour sessions of training on the Dragon NaturallySpeaking© Program. Following treatment, measures of language, computer skills, quality of life, and functional communication were re-administered. Further, to evaluate if skills in written expression could be utilised to communicate via e-mail, a distance-learning program was implemented. Outcomes & Results: Findings revealed that, with intensive instruction, the participant was able to independently access the computer and the Dragon NaturallySpeaking© Program. At the conclusion of the treatment phase, functional writing abilities approximated spoken communication. Some minor changes in reading, repetition, and conversation were suggested on formal and informal assessment measures. The participant made substantial gains in using the program in her activities of daily living, but only achieved minor success in demonstrating her skills during distance learning. Conclusions: The potential benefits of AAC devices may change throughout the course of recovery from aphasia. New technologies may facilitate gains in communication in individuals with aphasia throughout their lifespan. This study demonstrated that intensive training in the use of voice recognition software can enhance functional writing in an individual with chronic aphasia. Although marked progress in written expression was achieved, transfer of skills for use on the Internet was limited. Clinical management should include assessment of various assistive technologies across different modalities of communication for people at different stages of recovery from aphasia.

Left and Right Hemispheric Contributions to Discourse Coherence and Cohesion

Linguistic coherence and cohesion were examined in patients with unilateral left brain damage (LBD), unilateral right brain damage (RBD), and normal control (NC) right-handed adults. Groups were matched for age, gender, occupation, and education. Brain-damaged groups did not differ for months post onset or intrahemispheric lesion site. Contrary to previous literature, results indicated that LBDs, all of whom were aphasic, demonstrated impairments in coherence but not cohesion, relative to NCs and RBDs. Surprisingly, among RBDs, overall coherence and cohesion were spared. When the relationship between measures of coherence and cohesion was examined, there were few significant correlations and no systematic patterns. Results support the notion that coherence and cohesion represent coexisting and independent linguistic systems. Further, the findings suggest that descriptions of discourse integrity need to account for the perspective of both the speaker and listener.

Psychometric Aspects of Verbal Pragmatic Ratings

This study examined the psychometric aspects of a verbal pragmatic rating scale. The scale contained six pragmatic features (i.e., Conciseness, Lexical Selection, Quantity, Relevancy, Specificity, and Topic Maintenance) based on Grices cooperative principles. Fifteen right brain-damaged (RBD), 15 left brain-damaged (LBD), and 16 healthy normal control (NC) right-handed adult participants produced narratives while recollecting emotional and nonemotional experiences. Naive raters evaluated each pragmatic feature for appropriateness on a 5-point Likert scale. When reliability was examined, the overall internal consistency of the pragmatic scale was extremely high (alpha =.96). Factor analysis was conducted to examine the theoretical relations among the six pragmatic features. Three meaningful factors involving discourse content, conceptual unity, and parsimony were identified. Findings are discussed in light of Grices model and the construct validity of the scale.

Pragmatic breakdown in patients with left and right brain damage: Clinical implications

Formal and functional approaches to pragmatics are based upon different assumptions about the nature of the language system. This paper examines these approaches to pragmatics and considers how each approach has been applied to understand the different language disorders that emerge from left and right brain-damage. The paper explores conflicting reports in the literature about pragmatic performance and hemispheric side of lesion. Finally, clinical methods based on both the formal and functional approaches to pragmatics are discussed.