Transcript Post-Conversation Feedback in Adults with Right

Kelsey Meiring, M.A., CF-SLP
Indiana University
Speech and Hearing Sciences
[email protected]
Introduction
 Despite growing research focused on right-hemisphere
brain damage (RHD), there is still a lack of research
about this population, especially regarding treatment
of cognitive-linguistic deficits (Blake, 2007)
 Although many SLP’s do not evaluate or treat this
population very often (Blake, 2006), only half of those
with RHD cognitive-linguistic deficits are referred for
S/L services (Blake, Duffy, Myers, Tompkins, 2002 )
 Since research is increasing awareness of RHD, more
of these patients are likely to be referred for services,
so SLP’s need to be prepared to treat them
Etiology v. Deficits
 The study is a treatment study involving only right-
hemisphere TBI addressing the symptoms of RHD
 According to Blake (2007), treating the deficits of RHD
regardless of etiology is more appropriate; therefore, it
may also be applicable for right-hemisphere CVA
Purpose
 The purpose of this study is to investigate a possible
treatment protocol to address discourse and pragmatic
issues related to RHD.
 This treatment focuses on the use of feedback to
increase awareness of deficits and to provide ways to
improve discourse and pragmatic performance.
Normal Right Hemisphere Fx
 Production of automated speech and the comprehension
and production of prosody, emotional speech, narrative
discourse, and pragmatics (Lindell, 2006)
 Right-hemisphere is more involved in comprehension of
language than production (Baynes, Tramo, & Gazzaniga,
1992; Gazzaniga, LeDoux, & Wilson, 1977; Zaidel, 1978)
 Primarily responsible for integrating and producing
connections across sentences and within sentences in
discourse to obtain or convey the main idea (Gernsbacher
& Kaschak, 2003)
Deficits – Aprosodia
 Comprehension
 Inability to interpret prosody to deduce a meaning from
discourse. Therefore, jokes, sarcasm, and emotionally
ambiguous sentences are often difficult to understand for
this population
 Production
 Inability to produce prosody to express the intended
communicative intent. Therefore, expressing emotions and
conveying the correct form of sentences (e.g., interrogative
versus declarative sentence) are very difficult for this
population
 Can have a combo of these (Lindell, 2006)
Deficits – Discourse/Pragmatics
 Some variability in particular discourse and pragmatic deficits has been reported
(Blake, 2006; Myers, 2001)
 Common deficits:
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Disinhibition
Impulsivity
Verbosity or paucity
Unbalanced turn taking
Difficulty generating inferences
Lack of or inappropriate eye contact
Topic digressions and tangentiality
Inappropriate topic and/or word choice
Difficulty comprehending discourse
Egocentricity
Disorganization and lack of cohesion
Lack of initiation
Ideational perseveration
 (Blake, 2006; Chantraine, Joanette, & Ska, 1998; Glosser, 1993).
Deficits – Anosognosia
 Presence of anosognosia tends to lead to poorer
outcomes in treatment (Hartman-Maeir, Soroker,
Oman, & Katz, 2003; Jehkonen et al., 2001; Noe et al.,
2005)
 This issue is central to the premise of the study; if one
can become aware of his or her deficits, he or she may
then begin the process to develop strategies to
overcome these deficits.
Treatment – Aprosodia
 Most treatments for aprosodia only focus on expressive
deficits.
 The most common treatments for aprosodia following
RHD involve
 Biofeedback (Stringer, 1996),
 Cognitive-linguistic treatment (Leon et al., 2005;
Rosenbek et al., 2004; Stringer, 1996), and
 Imitative treatment with errorless learning cueing
hierarchies (Leon et al., 2005; Rosenbek et al., 2004).
Treatment – Discourse/Pragmatics
 Group treatment (Klonoff, Sheperd, O’Brien, Chiapello, &
Hodak, 1990)
 3 participants
 5 hours of therapy, 5 days a week
 Treatment involved role-playing, self-monitoring, and
behavioral reviews.
 Results were vague and did not formally assess pragmatics
or discourse but rather gave subjective information
regarding the progress in these areas.
 Self-monitoring continued to be an issue for most
participants at the termination of the group treatment.
 Group treatment - Murray and Clark (2006)
Treatment – Discourse/Pragmatics
 Most effective:
 Role-playing
 Self-monitoring
 Behavior modification
 Feedback, usually via videotape review
 (Coelho, DeRuyter, & Stein, 1996)
Treatment – Anosognosia
 Usually involves the prediction of performance on
certain tasks or the use of feedback, similar to the
treatments described for discourse and pragmatics
 Youngjohn and Altman (1989)
 36 brain-injured participants
 Predicted their performance on a free recall task and a
written math task
 Predictions and actual performance were reviewed with
the participants in a group setting
 More accurate self-predictions were reported by the end
of the treatment.
Ethical Issues – Anosognosia tx
 Cherney, 2006
 If the client does not see a need for treatment and refuses to
attend, therapy may ethically not be pursued.
 Even if the participant agrees to come to therapy, the lack of
awareness of deficits will result in little motivation to
participate and respond to treatment, which is essential to
successful treatment.
 Since unaware of the deficits, the participant cannot
participate in the development of treatment goals or express
his or her preferences for the direction of treatment.
 If anosognosia persists, treatment to address safety issues
still needs to be pursued at the discretion of the clinician.
Discourse Analysis
 There are many ways to analyze discourse, making
cross-study comparisons difficult (Togher, 2001)
 Lê, Mozeiko, and Coelho (2011) developed four main
areas of anaylsis of discourse:
 Within-sentence
 Across-sentence
 Text-level
 Story grammar analyses (Not used in this study)
Rationale of Study
 Many patients with RHD have anosognosia, or a lack
of awareness of deficits (Blake, 2006)
 Patients are unable to modify behavior if they are
unaware of the undesirable behavior
 Therefore, increase awareness, increase ability to
modify behavior
 How do we increase awareness?
 FEEDBACK
Methods
 Single-subject design
 Subject:
 62 year old female (“JB” to protect identity)
 Right TBI sustained after being hit by a car while on bicycle in
1987 (22 years post-onset)
 Presenting symptoms:
•Disinhibition
•Anosognosia
•Verbosity
•Lack of specificity
•Ideational perseveration
•Lack of transitions
•Frequent topic digressions
•Pragmatics (frequently
inappropriate)
 Subject’s symptoms consist with findings of Blake (2006),
although RHD deficits may vary widely among individuals –
reinforces idea to TREAT SYMPTOMS, not etiology
Methods (cont.)
 20 treatment visits
 2x/week, 60-minute session & 90-minute session
 Pre- and post- treatment testing
 4-6 week post-treatment testing
Methods (cont.)
 Discourse elicitation tasks:
 Story retell
 Spoken Conversation
 Written Conversation
 Only written conversation was analyzed
 5 probes in each task area were collected throughout
the study for a total of 15 probes in addition to pre- and
post- treatment probes
Methods (cont.)
 After each communication event, the subject was asked how
she believed she performed during the conversation, story
retell, etc. on several discourse measures using the following
scale:
Poor
2. Fair
3. Good
4. Better
5. Best
1.
 Then, investigator would provide a rating and give specific
examples supporting the rating.
 Also, teaching the participant on how to improve her ratings
was also targeted through discussion, examples, etc.
Example Prompts
 “On this scale, how well do you think you used
specific names of people, places, or things? How
well do you think you provided a reference for me
to know what you’re talking about?”
 “On this scale, how well do you think you used
transition words or phrases going from one topic of
the conversation to the next?”
 “On this scale, how well do you think you did on
talking for an equal amount of time as me during
the conversation?”
Within-sentence Analysis
 T-units
 Words
 Words per T-unit
 Subordinate clauses per T-unit
 Written output errors
 Nonspecific instances per T-unit
 Specific instances per T-unit
 Nonspecific instances with a clear referent per T-unit
Across-sentence Analysis
 Cohesive devices used per T-unit
 Effectiveness of cohesive devices used
 Types of cohesive devices used:
 Reference
 Ellipsis
 Substitution
 Conjunction
 Lexical Cohesion
Text-level Analysis
 Global Coherence
 Local Coherence
 Appropriateness
 Ideational Perseveration
 Questions (monologue v. dialogue)
Agreement
 Intra-rater: 90.7%
 Inter-rater: 55.5% with T-units
 Inter-rater: 77.2% without T-units
 Interpret results with caution
 Since much of JB’s written discourse was incomplete
sentences missing main components of a T-unit, such
as subjects, verbs, and objects, clear boundaries still
could not be established
Results – Formal Assessment
 Improvements in:
 visual scanning, visuoverbal processing, higher-level
language skills, and right-left differentiation
 auditory working memory, visual focused attention, and
visual-spatial working memory
 sustained auditory attention, divided attention, selective
attention, attention switching
 deductive reasoning skills, information integration,
hypothesis testing, flexibility of thinking, descriptive
narrative, and verbal abstraction skills
Results – Formal Assessment
Test of Everyday Attention
10
9
8
Scaled Scores
7
6
5
4
3
2
1
Beginning
0
Elevator Counting
(Correctly Counted
Strings)
Visual Elevator
(Accuracy)
Visual Elevator
(Timing)
Subtests
Telephone Search
(Time per Target)
Telephone Search
While Counting (Dual
Task Decrement)
End
Results – Formal Assessment
D-KEFS Word Context
8
7
Scaled Scores
6
5
4
Beginning
3
2
1
0
Total Consecutively Correct
Consistently Correct Ratio
Repeated Incorrect Responses
End
Results – Formal Assessment
D-KEFS Proverb Test
12
Scaled Scores
10
8
6
Beginning
4
2
0
Total Achievement Score
Uncommon Proverbs
Accuracy
End
Results – Formal Assessment
Weschler Memory Scale-III
12
11
Scaled Scores
10
9
Beginning
End
8
7
6
Letter-Number Sequencing
Spatial Span Forward
Spatial Span Backward
Total Spatial Span Score
Results – Agreement in Ratings
100%
90%
80%
Percentage of Agreement
70%
60%
50%
40%
30%
20%
10%
0%
1
2
3
4
5
6
7
8
9
10
11
12
Treatment Sessions
13
14
15
16
17
18
19
20
Results – Written Conversation
 Improvements in all areas, particularly:
 Length of emails
 Appropriateness of emails
 Questions asked in emails
 “Flow” of emails – less topic digressions and more
transitions used
 Specificity of language in emails – explained names,
acronyms, places, etc.
 Typing accuracy continued to be a struggle, but was
not a focus of the treatment study
Pre-treatment
 Familiar partner
 “Bcum was great I,ve always been a teacher.I,ve read
Doris kearns Goodwin.i miss you”
 Unfamiliar partner
 “happy Valinetine,s Day.speech and hearing used to be
the University gym.”
Week 3
 Familiar partner
 “Peters was fine and something happened there.I read
Goldilocks and the three bears.After that,theKindertend
class was talking about people with disabilities and they
talked about me.The teacher had .them write with their
weak hand,and it was hard..She said"dowe laugh at
people who have disabilities? they said noI It was
good.As Misty said I have things that go beyond my
disabilities..Thanks to Speech and Hearing.Bcum was
good as always.”
Week 3
 Unfamiliar partner
 “Bayside county united Ministries ,where I read to the
children, was good as always.Amutual admiration
society just like you people here at Speech and
Hearing.How are you and who are you?I,d like to meet
you sometime!”
Week 7
 Familiar partner
 “I havin,t talked to you for a long time. How,s
everything? I,m reading the Health care Bill with
Kelsey. What do you think of it? Too many specifics. As
George Will says "We have to wai.t and se how it plays
out.“ How,s your husband? Remember Misty,the good
ole Alpha Chi? She didn't have time for the computer,her
daughter,Melissa did. I got a computer Facebook letter
from her Good old computer! I miss you how,s Spring
break and how,s school?”
Week 9
 Unfamiliar partner
 “Now that I,ve got to know you on the computer.Today
was my birthday. Kelsey and Rebecca sent me a card. Ive
had a pretty good life . Do you like this weather? I hope
to meet you sometime in PERSON. Over and out”
Final Week
 Familiar partner
 “I haven,t talked to you in a long time. How is Nick and
Tutu and you? Are you ready for summer? Ididn,t go to
BCUM (Bayside CountyUnited Ministries) Thursday.
Iwalked with the walker last week . My knees are
getting better after the knee muscle tear Ihad the last
week. Just old age,I think. Are you ready for school? I
miss you and I love you”
Final Week
 Unfamiliar partner
 “Ive heard a lot about you. Are youa figment of Kelsey,s
imagination/? How is school? Did you go to
commencement? .I heard Quincy Jones and Dave Baker
from our Music-jazz school spoke. Are you ready for
summer?No classes going on. I love you.”
4-6 Weeks Post
 Familiar partner
 “How are you? Iknow your hubby and Tutu ,but who is
that new person you mentioned inthe bunch?I can't
remember. One bad thing happened tome this summer.
My apartment door was unlocked with no one in it and
my fanny pack was stolen, nomoneyinit. Just a hassle
(Kelsey taught me how to spell it) That's O.K. At least
my kitty Sofie wasn't stolen. Someone from Bayside
House took it. No big deal except my private space was
invaded. Howis the summer for you and Nick and Tutu?
Imiss seeing you here. I love you”
4-6 Weeks Post
 Unfamiliar partner
 “How are you? Quite a summer ,isn't it?I have no plans
'except school starting' reading to the kids at Peters,at
Bayside County United Ministries, and at my church
and here at Speech and Hearing and I'm fine . I. U. is
quite a place to be.isn't it? Over and out”
Results – T-units
18
16
14
T-units
12
10
Familiar
8
Unfamiliar
6
4
2
0
Pre-tx
1
2
3
4
5
Post-tx
6 Week Posttx
Results – Words
120
100
Number of Words
80
60
Familiar
Unfamiliar
40
20
0
Pre-tx
1
2
3
4
5
Post-tx
6 Week Posttx
Results – Words per T-unit
9
8
7
Words/T-unit
6
5
Familiar
4
Unfamiliar
3
2
1
0
Pre-tx
1
2
3
4
5
Post-tx
6 Week Posttx
Results – Specificity
2.5
Specific Instances/T-unit
2
1.5
Familiar
Unfamiliar
1
0.5
0
Pre-tx
1
2
3
4
5
Post-tx
6 Week Posttx
Results – Nonspecific with referent
0.9
Nonspecific with Referent/T-unit
0.8
0.7
0.6
0.5
Familiar
0.4
Unfamiliar
0.3
0.2
0.1
0
Pre-tx
1
2
3
4
5
Post-tx
6 Week Posttx
Cohesive Devices per T-unit
3
Cohesive Devices/T-unit
2.5
2
1.5
Familiar
Unfamiliar
1
0.5
0
Pre-tx
1
2
3
4
5
Post-tx
6 Week Posttx
Ineffective Cohesive Devices
60
50
Percentage
40
Familiar
30
Unfamiliar
20
10
0
Pre-tx
Post-tx
6 Week Post-tx
Types of Cohesive Devices Used
80
70
60
Percentage of References Familiar
Percentage of References Unfamiliar
Percentage of Ellipses Familiar
Percentage
50
Percentage of Ellipses Unfamiliar
Percentage of Conjunctions Familiar
40
Percentage of Conjunctions Unfamiliar
Percentage of Substitutions Familiar
30
Percentage of Substitutions Unfamiliar
Percentage of Lexical Cohesion Familiar
Percentage of Lexical Cohesion Unfamiliar
20
10
0
Pre-tx
Post-tx
6 Week Post-tx
Text-level Analysis Results
100.00%
90.00%
80.00%
Percentage
70.00%
60.00%
Pre-tx
50.00%
Post-tx
6 Week Post-tx
40.00%
30.00%
20.00%
10.00%
0.00%
Familiar
Unfamiliar
Global Coherence
Familiar
Unfamiliar
Local Coherence
Familiar
Unfamiliar
Appropriateness
Familiar
Unfamiliar
Ideational Perseveration
Ideational Perseveration
60.00%
50.00%
Percentage
40.00%
30.00%
Familiar
Unfamiliar
20.00%
10.00%
0.00%
Pre-tx
1
2
3
4
5
Post-tx
6 Week Posttx
Appropriate Questions Asked
6
Number of Questions
5
4
Familiar
3
Unfamiliar
2
1
0
Pre-tx
Post-tx
6 Week Post-tx
Word Length of Questions
8
Average word length of questions
7
6
5
Familiar
4
Unfamiliar
3
2
1
0
Pre-tx
1
2
3
4
5
Post-tx
6 Week
Post-tx
Spoken Discourse Analysis
 Data collected and resulting patterns observed in
written discourse appears to reflect that in the spoken
discourse probes
 The changes in spoken discourse were judged to be not
quite as dramatic as those in written discourse
 Despite the assumed similarities, conclusions may not
be drawn from this subjective account
 Notable difference in appropriateness of discourse –
increased in written, but appeared to decrease in
spoken
 Possibly due to increased comfort with investigator
Results Summary
 The most substantial improvements were made in
improving the overall cohesion of her written
discourse through the use of connecting her thoughts
with cohesive devices (local coherence), increasing the
effectiveness of the cohesive devices she used, and
decreasing instances of ideational perseveration
 She also increased the specificity of her language,
particularly with familiar conversation partners, and
nonspecific language with clear referents with
unfamiliar conversation partners
Results Summary (cont.)
 Her written discourse was also longer and more
meaningful through the use of including stories and
questions, which created more of a dialogue between
her and her conversation partners
 Not only did she increase the number of cohesive
devices she used during written discourse, but she also
used them more effectively and used a wider variety of
types of cohesive devices, making her written
discourse richer with more fluidity
 The appropriateness of her written discourse improved
Results – Some discrepancies
 Although JB made improvements in the written
procedural, story generation, and monologue
discourse tasks, her greatest gains involved writing to
actual people rather than writing non-motivating
discourse to no one (actually performed worse in some
areas on those tasks)
 Naturally, her written discourse had more meaningful
content to those who were familiar to her; however,
large gains were also seen in her written discourse with
unfamiliar partners
Results - Maintenance
 Conversational Discourse
 length and complexity of written discourse, increased
specificity, an increase in the number of cohesive devices
used, wider variability of cohesive devices used,
increased local coherence, increased appropriateness,
and decreased ideational perseveration
 Procedural, Picture Description, Monologue
 length of complexity of written discourse, increased
specificity, an increase in the number of cohesive devices
used, increased effectiveness of cohesive devices used,
wider variability of cohesive devices used, and increased
local coherence
Discussion
 Variability in the written discourse results was noted,
even within one task.
 Her performance may have been dependent on the
discourse task, which is consistent with findings from
Mentis and Prutting (1987) who found different
cohesion patterns in each participant, depending on if
the task was narrative or conversational in nature.
Discussion (cont.)
 JB’s difficulty with coherence may be explained by Kennedy
(2000), who suggested that many seemingly-irrelevant
comments during conversation from those with RHD may
actually be secondary topic scenes that they are unable to
inhibit or connect through the use of cohesive devices.
 JB would often have seemingly-extraneous comments that
would actually be related to the previous topic; however, no
connection was made between the two topics nor could she
inhibit the secondary topics.
 As she became aware of this lack of cohesion through the
treatment activities, she was better able to use cohesive devices
effectively to reduce topic digressions and increase local
coherence.
Discussion (cont.)
 The number and variety of cohesive devices JB used post-
treatment resembled those of normal healthy adults, as
reported by Mentis and Prutting (1987).
 Normal participants used cohesive ties approximately 60%
of the time whereas those with TBI used ties only 30% of
the time. JB’s local coherence of using ties 57.14% of the
time when writing to unfamiliar conversation partners thus
resembles data from normal healthy adults more so than
those with TBI.
 Additionally, the wider variety of types of cohesive devices
used by JB post-treatment also reflects patterns used by
normal healthy adults, particularly with the increased use
of lexical cohesion (Mentis & Prutting, 1987).
Discussion (cont.)
 Although JB made improvements in the written
procedural, story generation, and monologue
discourse tasks, her greatest gains involved writing to
actual people (written conversation tasks) rather than
writing non-motivating discourse to no certain person
(i.e., performance of procedural, story generation, and
monologue tasks).
Limitations
 Inter-rater agreement not adequate
 No multiple baseline data collected
 Number of participants
 Spoken data not analyzed
 Variability in the written discourse results was noted,
even within one task
Clinical Implications
 Spoken conversation probes that were collected appear to
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reflect the results in written conversation probes
Easy-to-use scale to promote self-feedback and awareness
of conversation skills
Can individualize targets to reflect patients’ deficits
Can individualize scale for different cognitive levels
Inexpensive
No harm
Can use for different modalities (writing, speaking, etc.)
Can use in a variety of settings (SNF, outpatient rehab,
inpatient rehab, group treatment, etc.)
Considerations
 Must be able to take detailed notes during
conversation about discourse targets to support rating
you assign while still participating in conversation
 Must be able to be honest with patient – try to write
down your rating before you hear theirs
 Must pick up on instances of “dishonesty” of ratings
from patient
More Considerations
 Beware of extremely “off” ratings from patient – they may
not be able to accurately self-evaluate at first, but if this
still persists into treatment, may not be effective for that
individual
 Beware of no change in targets, even if ratings are accurate
– they may be able to self-evaulate, but may have difficulty
modifying their behavior to achieve higher ratings
 Always encourage them to strive for the highest rating!
 With increased awareness, some patients will become
confused, depressed, angry, resistant, etc. – PROCEED
WITH CAUTION!
References
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Ackermann, H., & Riecker, A. (2004). The contribution of the insula to motor aspects of speech
production: A review and a hypothesis. Brain and Language, 89, 320–328.
Alho, K., Vorobyev, V. A., Medvedev, S. V., Pakhomov, S. V., Roudas, M. S., Terveniemi,M., et al.
(2003). Hemispheric lateralization of cerebral blood-flow changes during selective listening to
dichotically presented continuous speech. Cognitive Brain Research, 17, 201–211.
Baynes, K., Tramo, M. J., & Gazzaniga, M. S. (1992). Reading with a limited lexicon in the right
hemisphere of a callosotomy patient. Neuropsychologia, 30, 187–200.
Benowitz, L. I., Moya, K. L., & Levine, D. N. (1990). Impaired verbal reasoning and constructional
apraxia in subjects with right hemisphere damage. Neuropsychologia, 28, 231–241.
Bhatnagar, S. (2008). Neuroscience for the Study of Communicative Disorders (3rd ed.). Philadelphia,
PA: Lippincott Williams & Wilkins.
Blake, M. L., Duffy, J. R., Myers, P. S., & Tompkins, C. A. (2002). Prevalence and patterns of right
hemisphere cognitive/communicative deficits: Retrospective data from an inpatient rehabilitation
unit. Aphasiology, 16, 537–548.
Blake, M.L. (2006). Clinical relevance of discourse characteristics after right hemisphere brain
damage. American Journal of Speech-Language Pathology, 15, 255-267.
Blake, M.L. (2007). Perspectives on treatment for communication deficits associated with right
hemisphere brain damage. American Journal of Speech-Language Pathology, 16(4), 331-342.
Blake, M.L. (2009a). Inferencing processes after right hemisphere brain damage: Effects of contextual
bias. Journal of Speech, Language, and Hearing Research, 52, 373-384.
Blake, M.L. (2009b). Inferencing processes after right hemisphere brain damage: Maintenance of
inferences. Journal of Speech, Language, and Hearing Research, 52, 359-372.
Brady, M., Mackenzie, C., & Armstrong, L. (2003). Topic use following right hemisphere brain damage
during three semistructured conversational discourse samples. Aphasiology, 17, 881–904.
References (cont.)
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Brookshire, R. H. & Nicholas, L. E. (1993). The Discourse Comprehension Test. Tucson, AZ: Communication
Skill Builders/The Psychological Corporation.
Brotherton, F.A., Thomas, L.L., Wisotzek, I.E., & Milan, M.A. (1988). Social skills training in the
rehabilitation of patients with traumatic closed head injury. Archives of Physical Medicine and
Rehabilitation, 69, 827-832.
Brownell, H. H., Potter, H. H., Bihrle, A. M., & Gardner, H. (1986). Inference deficits in right brain-damaged
patients. Brain and Language, 27, 310–321.
Burke, W.H., & Lewis, F.D. (1986). Management of maladaptive social behavior of a brain injured adult.
International Journal of Rehabilitation Research, 9, 335-342.
Burke, W.H., Zencius, A.H., & Weslowski, M.D. (1991). Improving executive function disorders in braininjured clients. Brain Injury, 5, 241-252.
Channon, S., & Watts, M. (2003). Pragmatic language interpretation after closed head injury: Relationship to
executive functioning. Cognitive Neuropsychiatry, 8, 243–260.
Chantraine, Y., Joanette, Y., & Ska, B. (1998). Conversational abilities in patients with right hemisphere
damage. Journal of Neurolinguistics, 11, 21–32.
Cherney, L. R. (2006). Ethical issues involving the right hemisphere stroke patient: To treat or not to treat?
Topics in Stroke Rehabilitation, 13, 47–53.
Cherney, L. R., Drimmer, D. P., & Halper, A. S. (1997). Informational content and unilateral neglect: A
longitudinal investigation of five subjects with right hemisphere damage. Aphasiology, 11, 351–363.
Cicerone, K.D., & Giacino, J.T. (1992). Remediation of executive function deficits after traumatic brain
injury. Neuropsychological Rehabilitation, 2, 12-22.
References (cont.)









Coelho, C.A. (2002). Story narratives of adults with closed head injury and non-brain-injured adults:
Influence of socioeconomic status, elicitation task, and executive functioning. Journal of Speech,
Language, and Hearing Research, 45, 1232-1248.
Coelho, C.A., DeRuyter, F., & Stein, M. (1996). Treatment efficacy: Cognitive-communicative
disorders resulting from traumatic brain injury in adults. Journal of Speech, Language, and Hearing
Research, 39, S5-S17.
Delis, D., Kaplan, E., & Kramer, J. (2001). Delis-Kaplan Executive Function Scale. San Antonio, TX: The
Psychological Corporation.
Dogil, G., Ackermann, H., Grodd,W., Haider, H., Kamp, H.,Mayer, J., et al. (2002). The speaking brain:
a tutorial introduction to fMRI experiments in the production of speech, prosody and syntax. Journal
of Neurolinguistics, 15, 59–90.
Ehrlich, J., & Sipes, A. (1985). Group treatment of communication skills for head trauma patients.
Cognitive Rehabilitation, 3, 32-37.
Gajar, A., Schloss, P.J., Schloss, C.N., & Thompson, C.K. (1984). Effects of feedback and selfmonitoring on head trauma youths’ conversational skills. Journal of Applied Behavior Analysis, 17,
353-358.
Gazzaniga, M. S., LeDoux, J. E., & Wilson, D. H. (1977). Language, praxis and the right hemisphere:
Clues to some mechanisms of consciousness. Neurology, 27, 1144–1147.
Gernsbacher, M. A., & Kaschak, M. P. (2003). Neuroimaging studies of language production and
comprehension. Annual Review of Psychology, 54, 91–114.
Ghika-Schmid, F., van Melle, G., Guex, P., & Bogousslavsky, J. (1999). Subjective experience and
behavior in acute stroke: The Lausanne Emotion in acute stroke study. Neurology, 52, 22-28.
References (cont.)










Giles, G.M., Fussey, I., & Burgess, P. (1988). The behavioral treatment of verbal interaction skills
following severe head injury: A single case study. Brain Injury, 2, 75-79.
Glosser, G. (1993). Discourse patterns in neurologically impaired and aged populations. In H. H.
Brownell & Y. Joanette (Eds.), Narrative discourse in neurologically impaired and normal aging adults (
pp. 191–212). San Diego, CA: Singular.
Halper, A. S., Cherney, L. R., & Burns, M. S. (1996). Clinical management of right hemisphere
dysfunction (2nd ed.). Gaithersburg, MD: Aspen.
Hartman-Maeir, A., Soroker, N., Oman, S. D., & Katz, N. (2003). Awareness of disabilities in stroke
rehabilitation—a clinical trial. Disability and Rehabilitation, 25, 1, 35–44.
Hartman-Maeir, A., Soroker, N., Ring, H., & Katz, N. (2002). Awareness of deficits in stroke
rehabilitation. Journal of Rehabilitation Medicie, 34, 158-164.
Hay, E., & Moran, C. (2005). Discourse formulation in children with closed head injury. American
Journal of Speech-Language Pathology, 14(4), 324-336.
Helffenstein, D., & Wechsler, R. (1982). The use of interpersonal process recall (IPR) in the
remediation of interpersonal and communication skill deficits in the newly brain injured. Clinical
Neuropsychology, 4, 139-143.
Hotz, G., & Helm-Estabrooks, N. (1995). Perseveration. Part I: A review. Brain Injury, 9(2), 151-159.
Hunt, K. (1965). Differences in grammatical structures written at three grade levels (NCTE Research
Report No. 3). Urbana, IL: National Council of Teachers of English.
Jehkonen, M., Ahonen, J. P., Dastidar, P., Koivisto, A. M., Laippala, P., Vilki, J., et al. (2001). Predictors
of discharge to home during the first year after right hemisphere stroke. Acta Neurologica
Scandinavia, 104, 136–141.
References (cont.)










Kemeny, S., Ye, F. Q., Birn, R., & Braun, A. R. (2005). Comparison of continuous overt speech fMRI
using BOLD and arterial spin labelling. Human Brain Mapping, 24, 173–183.
Kempler, D., Van Lancker, D., Marchman, V., & Bates, E. (1999). Idiom comprehension in children and
adults with unilateral brain damage. Developmental Neuropsychology, 15, 327–349.
Kennedy, M.R.T. (2000). Topic scenes in conversations with adults with right-hemisphere brain
damage. American Journal of Speech-Language Pathology, 9(1), 72-86.
Klonoff, P. S., Sheperd, J. C., O’Brien, K. P., Chiapello, D. A., & Hodak, J. A. (1990). Rehabilitation and
outcome of right-hemisphere stroke patients: Challenges to traditional diagnostic and treatment
methods. Neuropsychology, 4, 147–163.
Lê, K. , Mozeiko, J. & Coelho, C. (2011, February 15). Discourse Analyses: Characterizing CognitiveCommunication Disorders Following TBI. The ASHA Leader.
Lê, K., Coelho, C., Mozeiko, J., & Grafman, J. (2011). Measuring goodness of story narratives. Journal
of Speech, Language, and Hearing Research, 54, 118-126.
Lehman, M. T., & Tompkins, C. A. (2000). Inferencing in adults with right hemisphere brain damage:
An analysis of conflicting results. Aphasiology, 14, 485–499.
Lehman-Blake, M., & Tompkins, C.A. (2001). Predictive inferencing in adults with right hemisphere
brain damage. Journal of Speech, Language, and Hearing Research, 44(3), 639-654.
Leon, S. A., Rosenbek, J. C., Crucian, G. P., Hieber, B., Holiway, B., Rodriguez, A. D., et al. (2005).
Active treatments for aprosodia secondary to right hemisphere stroke. Journal of Rehabilitation
Research and Development, 42, 93–102.
Lewis, F.D., Nelson, J., Nelson, C., & Reusink, P. (1988). Effects of three feedback contingencies on
the socially inappropriate talk of a brain-injured adult. Behavior Therapy, 19, 203-211.
References (cont.)










Liles, B.Z., Coelho, C.A., Duffy, R.J., & Zalagens, M.R. (1989). Effects of elicitation procedures on the
narratives of normal and closed head-injured adults. Journal of Speech and Hearing Disorders, 54,
356-366.
Lindell, A.K. (2006). In your right mind: Right hemisphere contributions to language processing and
production. Neuropsychology Review, 16, 131-148.
MacWhinney, B. (2000). The CHILDES project: Tools for analyzing talk (3rd ed.). Mahwah, NJ:
Lawrence Erlbaum Associates.
Marini, A., Carlomagno, S., Caltagirone, C., & Nocentini, U. (2005). The role played by the right
hemisphere in the organization of complex textual structures. Brain and Language, 93, 46–54.
Martin, I., & McDonald, S. (2003).Weak coherence, no theory of mind, or executive dysfunction?
Solving the puzzle of pragmatic language disorders. Brain and Language, 85, 451–466.
McDonald, S. (2000). Exploring the cognitive basis of right hemisphere pragmatic language disorders.
Brain and Language, 75, 82–107.
McDonald, S., & Pearce, S. (1998). Requests that overcome listener reluctance: Impairment associated
with executive dysfunction in brain injury. Brain and Language, 61, 88–104.
Mentis, M., & Putting, C.A. (1987). Cohesion in the discourse of normal and head-injured adults.
Journal of Speech and Hearing Research, 30, 88-98.
Murray, L. L., & Clark, H. M. (2006). Neurogenic disorders of language: Theory driven clinical practice.
Clifton Park, NY: Thomson Delmar.
Myers, P. S. (1979). Profiles of communication deficits in patients with right cerebral hemisphere
damage. In R. H. Brookshire (Ed.), Clinical Aphasiology Conference proceedings (Vol. 9, pp. 38–46).
Minneapolis, MN: BRK.
References (cont.)










Myers, P. S. (1999a). Right hemisphere disorder: Disorders of communication and cognition. San Diego,
CA: Singular.
Myers, P. S. (1999b). Process-oriented treatment of right hemisphere communication disorders.
Seminars in Speech and Language, 20, 319–333.
Myers, P. S. (2001). Toward a definition of RHD syndrome. Aphasiology, 15, 913–918.
Myers, P. S., & Brookshire, R. H. (1996). The effect of visual and inferential variables on scene
descriptions of right hemisphere-damaged and non-brain-damaged adults. Journal of Speech and
Hearing Research, 39, 870–880.
Myers, P. S., & Linebaugh, C. W. (1981). Comprehension of idiomatic expressions by righthemisphere-damaged adults. In R. H. Brookshire (Ed.), Clinical aphasiology (Vol. 11, pp. 254–261).
Minneapolis, MN: BRK.
Noe, E., Ferri, J., Caballero, M. C., Villodre, R., Sanchez, A., & Chirivella, J. (2005). Self-awareness after
acquired brain injury: Predictors and rehabilitation. Journal of Neurology, 252, 168–175.
Pimental, P., & Knight, J. (2000). Mini Inventory of Right Brain Injury (2nd ed.). Austin, TX: PRO-ED.
Ponsford, J. (2004). Rehabilitation following traumatic brain injury and cerebrovascular accident. In J.
Ponsford (Ed.), Cognitive and behavioral rehabilitation: From neurobiology to clinical practice ( pp.
299–342). New York: Guilford Press.
Prigatano, G. P. (1996). Behavioral limitations TBI patients tend to underestimate: A replication and
extension to patients with lateralized cerebral dysfunction. The Clinical Neuropsychologist, 10, 191–
201.
Robertson, I. H., Ward, T., Ridgeway, V., & Nimmo-Smith, I. (1994). The Test of Everyday Attention.
Gaylord, MI: Northern Speech Services.
References (cont.)









Robertson, I.H., & Halligan, P.W. (1999). Spatial neglect: A clinical handbook for diagnosis and
treatment. Hove, East Sussex. UK: Psychology Press.
Rosenbek, J. C., Crucian, G. P., Leon, S. A., Hieber, B., Rodriguez, A. D., Holiway, B., et al. (2004).
Novel treatments for expressive aprosodia: A phase I investigation of cognitive linguistic and imitative
interventions. Journal of the International Neuropsychological Society, 10, 786–793.
Rosenbek, J.C., Rodriguez, A.D., Hieber, B., Leon, S.A., Crucian, G.P., Ketterson, T.U., et al. (2006).
Effects of two treatments on aprosodia secondary to acquired brain injury. Journal of Rehabilitation
Research & Development, 43(3), 379-390.
Stringer, A. Y. (1996). Treatment of motor aprosodia with pitch biofeedback and expression modeling.
Brain Injury, 10, 583–590.
Togher, L. (2001). Discourse sampling in the 21st century. Journal of Communication Disorders, 34,
131-150.
Tompkins, C. A. (1995). Right hemisphere communication disorders: Theory and management. San
Diego, CA: Singular.
Tompkins, C. A., & Baumgaertner, A. (1998). Clinical value of online measures for adults with right
hemisphere brain damage. American Journal of Speech-Language Pathology, 7(1), 68–74.
Tompkins, C. A., Baumgaertner, A., Lehman, M. T., & Fassbinder, W. (2000). Mechanisms of
discourse comprehension impairment after right hemisphere brain damage: Suppression and
enhancement in lexical ambiguity resolution. Journal of Speech, Language, and Hearing Research, 43,
62–78.
Tompkins, C. A., Baumgaertner, A., Lehman, M. T., & Fossett, T. R. D. (1997). Suppression and
discourse comprehension in right brain-damaged adults: A preliminary report. Aphasiology, 11, 505–
519.
References (cont.)








Tompkins, C. A., Boada, R., McGarry, K., Jones, J., Rahn, A. E., & Ranier, S. (1993). Connected speech
characteristics of right-hemisphere-damaged adults: A re-examination. In M. Lemme (Ed.), Clinical
aphasiology (Vol. 21, pp. 113–122). Austin, TX: Pro-Ed.
Tompkins, C. A., Fassbinder,W., Blake, M. L., Baumgaertner, A., & Jayaram, N. (2004). Inference
generation during text comprehension by adults with right hemisphere brain damage: Activation
failure versus multiple activation. Journal of Speech, Language, and Hearing Research, 47, 1380–1395.
Tompkins, C. A., Lehman-Blake, M. T., Baumgaertner, A., & Fassbinder, W. (2001). Mechanisms of
discourse comprehension impairment after right hemisphere brain damage: Suppression in
inferential ambiguity resolution. Journal of Speech, Language, and Hearing Research, 44, 400–415.
Tompkins, C. A., Lehman-Blake, M., Baumgaertner, A., & Fassbinder, W. (2002). Characterizing
comprehension difficulties after right brain damage: Attentional demands of suppression function.
Aphasiology, 16, 559–572.
Turner, G. R., & Levine, B. (2004). Disorders of executive functioning and self-awareness. In J.
Ponsford (Ed.), Cognitive and behavioral rehabilitation: From neurobiology to clinical practice ( pp.
224–268). New York: Guilford Press.
Uryase, D., Duffy, R. J., & Liles, B. Z. (1991). Analysis and description of narrative discourse in righthemisphere-damaged adults: A comparison with neurologically normal and left hemispheredamaged aphasic adults. Clinical Aphasiology, 19, 125–138.
Wapner, W., Hamby, S., & Gardner, H. (1981). The role of the right hemisphere in the apprehension of
complex linguistic material. Brain and Language, 14, 15–32.
Wapner, W., Hamby, S., & Gardner, H. (1981). The role of the right hemisphere in the apprehension of
complex linguistic materials. Brain and Language, 14, 15–33.
References (cont.)




Wechsler, D. (1997). Wechsler Memory Scale (3rd ed.). San Antonio, TX: The Psychological
Corporation.
Youngjohn, J.R., & Altman, I.M. (1989). A performance-based group approach to the treatment of
anosognosia and denial. Rehabilitation Psychology, 34(3), 217-222.
Zaidel, E. (1978). Lexical organization in the right hemisphere. In P. A. Buser & A. Rougeul-Buser
(Eds.), Cerebral correlates of conscious experience. Amsterdam: Elsevier.
Zencius, A.H., Wesolowski, M.D., & Burke, W.H. (1990). The use of a visual cue to reduce profanity in
a brain injured adult. Behavioral Residential Treatment, 5, 143-147.