Application of Our Problem: Biological Correlates of Language Right Brain Syndrome Application of Our Problem: Biological Correlates of Language

Description in Literature http://www.mugsy.org/shields1.htm SEMANTIC-PRAGMATIC LANGUAGE DISORDER Interesting comparisons can be drawn between these communication deficits observed in some patients with acquired right hemisphere lesions and those described in children with semantic-pragmatic language disorder. Both groups seem to have an underlying difficulty in integrating information, which is reflected in their verbal output. Both groups have relatively intact language form, using fluent, grammatically complex language, but show communication which is impaired by abnormal language content and use. Both groups have poor comprehension and use of non-verbal communication and prosody and both groups perform better on structured tasks than on open-ended ones, making fewer errors in concrete, literal tasks. Both have difficulty in assimilating and using contextual cues. Both tend to lend literal interpretation to figurative language and find difficulty coping with metaphor and humour. Both groups give impulsive answers full of tangential detail and have difficulty in distinguishing the important from the unimportant. Both are reluctant to admit to their communication problems. Both have a reduced sensitivity to the communicative situation and to pragmatic and extralinguistic aspects of communication (Myers, 1978, 1979, 1981; Culloden, Hyde-Wright & Shipman, 1986; Bishop & Rosenbloom, 1987; Bryan, 1988; Bishop & Adams, 1989).

Treatment Plan Select target behaviros Develop stimulus materials Describe baseline conditions for targeted impairments Provide extensive opportunities for practice Provide intensive practice Use instruction and prompts throughout treatment cycle

Right Brain Syndrome Injury and consequences associated with trauma to the right hemisphere The consequences may/do include perceptual, emotional, attentional and communicative impairments

Continued Shape behaviors Fade prompts Provide reinforcement and feedback immediately

Treatment Targets Lack of awareness Impaired attention Pragmatic skills Impaired reasoning Impaired inference Impaired comprehension of metaphor Impaired recognition of absurdities

Given these treatment targets, then Important language functions are governed by right hemisphere activity What generalization about the right hemisphere describes its importance to language?

Listing some of the right brain functions Integration Synthesis Analogizing Recognition of meaning from nonverbal information Interpretation of the emotional content or connotative level of meaning

Treatment strategies Although each type of impairment requires its own treatment protocol, there are important continuities throughout all of the impairments that need to be addressed

Common treatment strategies Use of spoken cues to get and maintain attention Support of oral language with written and pictorial materials Focus on communicative treatment targets Develop other, more advanced communication strategies (don’t stay at the literal level of shared speech)

Continued Use materials that follow a progression from simple to complex Use materials that have meaning for the client Use materials that unambiguous

Continued Use a variety of treatment stimuli Combine visual, written and oral prompts Reduce distracting stimuli initially Sustained use of speech that draws attention to therapist Use colors and gesture to direct attention to desired information that might be neglected (such as avoiding information on the right or left side of the visual field)

Continued Teach client to draw up plans Teach client to question how a plan could be put into action Teach client to quiz himself/herself Use pictures that contain logical and absurd material. Have client differentiate them Use stories with logical and illogical endings Again have client differentiate

Continued Discuss differences between logical and absurd Use cartoons and pair cartoons with captions Employ functional memory aids Teach compensatory strategies