Adults who damage in the right hemisphere of the brain (RHD), whether from stroke or from traumatic brain injury, can have a variety of problems with language comprehension, many of which are socially handicapping. Adults with RHD are especially likely to have comprehension difficulty when there is some incongruity in what they need to understand. For example, adults with RHD may have trouble activating, or bringing to mind, less-central aspects of meaning (e.g., an apple can be, but is not usually, rotten). This has been called a problem with 'coarse coding'of meaning and it can affect almost any form of communication, including inferencing and humor. Alternatively, adults with RHD may have trouble 'suppressing,'or discarding, one interpretation in favor of another (e.g., holding on to the 'ink'meaning of the word 'pen'in a scenario where a farmer is building a pen for his pigs). This problem also impedes social communication in various ways. Despite the potentially life-altering difficulties created by these problems, there is no evidence on how best to treat the language processing deficits of adults with RHD, and speech-language clinicians often 'fly by the seat of their pants.' The proposed research is the first significant attempt to develop a treatment for adults with RHD who have coarse coding or suppression deficits, and to conduct a preliminary, rigorous test of the effects of that treatment. The elements of treatment are based on sound theory and strong basic research about comprehension difficulties that face adults with RHD, and the approach is highly novel.
We aim for 3-4 participants to receive the treatment for coarse coding deficit and another 3-4 to receive the treatment for suppression deficit. We hypothesize that this novel treatment will yield positive effects that are broad in scope, and we will assess this hypothesis with measures of broad outcomes. For example, we will assess generalization of treatment effects to the comprehension of stories, figurative language, and scenarios that require the listener to identify and ignore less relevant information or to weigh competing options. The results of this preliminary work, however they turn out, will point the way for future treatment studies that provide sound evidence for clinicians who treat the life-altering communication deficits of adults with RHD.
Stroke is the leading cause of serious long-term disability in the United States. Adults who have strokes in the right side of the brain often 'miss the point'of what they hear, read, or see -- a life-altering problem that can have devastating effects on jobs, relationships, and spiritual and leisure pursuits. At present, there is essentially no evidence to help clinicians decide how to treat these problems. The proposed treatment study is designed to begin the process of collecting this much-needed evidence.
| Blake, Margaret Lehman; Tompkins, Connie A; Scharp, Victoria L et al. (2015) Contextual Constraint Treatment for coarse coding deficit in adults with right hemisphere brain damage: generalisation to narrative discourse comprehension. Neuropsychol Rehabil 25:15-52 |
| Tompkins, Connie A; Scharp, Victoria L; Meigh, Kimberly et al. (2012) Generalization of a Novel, Implicit Treatment for Coarse Coding Deficit in Right Hemisphere Brain Damage: A Single Subject Experiment. Aphasiology 26:689-708 |
| Tompkins, Connie A (2012) Rehabilitation for cognitive-communication disorders in right hemisphere brain damage. Arch Phys Med Rehabil 93:S61-9 |
| Tompkins, Connie A; Blake, Margaret T; Wambaugh, Julie et al. (2011) A novel, implicit treatment for language comprehension processes in right hemisphere brain damage: Phase I data. Aphasiology 25:789-799 |
