Perspectives on Treatment for Communication Deficits Associated With Right Hemisphere Brain Damage

Abstract

Purpose To describe the current treatment research for communication (prosodic, discourse, and pragmatic) deficits associated with right hemisphere brain damage and to provide suggestions for treatment selection given the paucity of evidence specifically for this population. Method The discussion covers (a) clinical decision processes and evidence-based practice; (b) a review of right hemisphere communication deficits and existing treatment studies; (c) accounts of right hemisphere function, right hemisphere deficits, and theoretically motivated treatments; and (d) a guide for exploring and selecting treatments based on deficits rather than etiology. Conclusions Controlled treatment studies for communication deficits specifically for adults with right hemisphere brain damage are limited to aprosodia. For other communication deficits, clinicians may select treatments based on current theories of right hemisphere function and right hemisphere deficits, and/or treatments developed for other etiologies for which deficits are similar to those associated with right hemisphere damage.

Clinical Focus on Prosodic, Discursive and Pragmatic Treatment for Right Hemisphere Damaged Adults: What's Right?

“…The scientific community particularly regrets that no evidence-based treatment is available to clinicians [33]. Nonetheless, review of literature since the year 2000 demonstrates that a fair number of reports on RHD rehabilitation exist.…”

“…In the absence of evidence, other cues based on theoretical hypothesis were suggested by Blake [33]. For instance, she suggests a treatment based on the acknowledged difficulties to use the context, by discussing alternate words or sentences' meaning according to a given context.…”

“…Therapists would then ask the patient to retell narratives he/she heard, to imagine himself/herself engaging in debates and controversy topics while decreasing verbal and visual feedback. Apart from the previous study from Klonoff, mentioned previously in former reviews [33], to our knowledge, no other formal study on discourse with RHD has been conducted. …”

“…Considering evidence-based treatments for RHD adults, Blake [33] underlines that treatment can be either theoretically motivated or based on deficits. Looking at accounts of normal right hemisphere function, the current knowledge doesn't seem sufficient to totally rely on the latter option.…”

“…As suggested by Blake [33], it would be wise to compare communication deficits caused by different etiologies (focal versus diffuse damage) in order to establish whether similar interventions could be designed for both populations. …”