Contextual Constraint Treatment for coarse coding deficit in adults with right hemisphere brain damage: Generalisation to narrative discourse comprehension

Abstract

Coarse coding is the activation of broad semantic fields that can include multiple word meanings and a variety of features, including those peripheral to a word’s core meaning. It is a partially domain-general process related to general discourse comprehension and contributes to both literal and non-literal language processing. Adults with damage to the right cerebral hemisphere (RHD) and a coarse coding deficit are particularly slow to activate features of words that are relatively distant or peripheral. This manuscript reports a pre-efficacy study of Contextual Constraint Treatment (CCT), a novel, implicit treatment designed to increase the efficiency of coarse coding with the goal of improving narrative comprehension and other language performance that relies on coarse coding. Participants were four adults with RHD. The study used a single-subject controlled experimental design across subjects and behaviors. The treatment involves pre-stimulation, using a hierarchy of strong- and moderately-biased contexts, to prime the intended distantly-related features of critical stimulus words. Three of the four participants exhibited gains in auditory narrative discourse comprehension, the primary outcome measure. All participants exhibited generalization to untreated items. No strong generalization to processing nonliteral language was evident. The results indicate that CCT yields both improved efficiency of the coarse coding process and generalization to narrative comprehension.

Preliminary study of higher‐order language and extralinguistic impairments in individuals with high clinical risk of psychosis and first episode of schizophrenia

“…The RH also plays an important role in appreciating humour and sarcasm (Bartolo, Benuzzi, Nocetti, Baraldi, & Nichelli, 2006;Heath & Blonder, 2005;Joanette et al, 2008;Marinkovic et al, 2011), processing indirect speech acts (Vanhalle et al, 2000), as well as comprehending narrative speech (Babajani-Feremi, 2017;Robertson, Gernsbacher, Guidotti, et al, 2000) and discourse (Blake, Tompkins, Scharp, Meigh, & Wambaugh, 2015;Johns, Tooley, & Traxler, 2008;Tompkins, Scharp, Meigh, & Fassbinder, 2008).…”

Voxel-Based Lesion Symptom Mapping of Coarse Coding and Suppression Deficits in Patients With Right Hemisphere Damage

“…Better diagnosis of these difficulties should help clinicians shape behavioral intervention choices as well. Recent evidence, for example, substantiates the promise of a novel theoretically and empirically based contextual constraint treatment (Blake et al, 2015;Tompkins et al, 2013;Tompkins, Scharp, et al, 2012) that targets these deficits. Early work suggests that this treatment approach, with separate versions for CC or SUP processes, yields generalized improvement to narrative comprehension in adults with RHD.…”

“…Armed with knowledge of an individual patient's lesion and the lesion patterns associated with deficits in early CC, maintenance of CC, and SUP, clinicians will have an important supplement to behavioral diagnostic assessments. Identification of these deficits has implications beyond the lexical level to the domain of narrative comprehension (e.g., Tompkins et al, 2000; and possibly to other processes that may involve CC and SUP (e.g., Blake et al, 2015;Tompkins et al, 2013). Better diagnosis of these difficulties should help clinicians shape behavioral intervention choices as well.…”

“…Per a large database of semantic distance norms (Maki, McKinley, & Thompson, 2004), the dominant-incompatible features were more semantically distant from their core concept . Thus, Tompkins, Fassbinder, and colleagues (Blake, Tompkins, Scharp, Meigh, & Wambaugh, 2015;Tompkins, Blake, Scharp, Meigh, & Wambaugh, 2013;Tompkins, Scharp, Meigh, Blake, & Wambaugh, 2012) refined the concept of RHD CC deficit and operationalized it in terms of a difficulty activating or maintaining activation for particularly remote or atypical information, such as dominant-incompatible semantic features. It is in that sense that the term CC deficit is used in this article.…”

Making It Right? Some Thoughts about the Future of Treatment for Right Hemisphere Cognitive-Communication Disorders

“…For language and communication disorders in RHD, clinicians' knowledge will also increase of intervention options beyond the standard metalinguistic tasks, including implicit approaches to treatment. 1,11,12 As a result of this growth in knowledge, I hope that an overreliance on apps (the modern-day workbooks) in some quarters, without careful consideration of the validity of their evidence or rationales, will decrease. I hope too that a healthy skepticism, the consumer's and clinician's friend, continues to be fueled by legitimate concerns such as those about the grossly exaggerated claims of "brain training" software 13 (which recently resulted in a large legal settlement with the FTC by one purveyor of such programs 14 ).…”