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Discourse Production and Right Hemisphere Disorder
Jamila Minga
Department of Allied Professions, Communication Disorders Program,
North Carolina Central University
Durham, NC
Disclosures
Financial: The author has no relevant financial interests to disclose.
Nonfinancial: The author has no relevant nonfinancial interests to disclose.
Abstract
Discourse production deficits associated with right hemisphere disorder (RHD) can impede
aspects of daily living, including socialization, community reintegration, and vocational
duties. Adults with RHD are referred to speech-language pathologists (SLPs) infrequently.
However, a growing interest in the pragmatic ramifications of acquired brain damage may
result in an increase of referrals in the future. For this reason, it will be important for
SLPs to be familiar with basic knowledge pertaining to communication behaviors across
discourse genres. The purpose of this article is to provide a broad foundation of the
behavioral manifestations of discourse production deficits following RHD, in hopes of
providing practical information applicable to the practicing clinician.
Efficient and pragmatically appropriate production of various discourse genres is essential
to communication. Informing medical staff of events that led to an injury, describing how to
assemble a child’s toy, and engaging in dialogue over dinner are just a few communicative
interactions that highlight the ubiquity of genre-specific discourses in daily communication.
Adults without brain damage may effortlessly use a myriad of discourse genre to complement
social interaction. However, right hemisphere brain disorder (RHD) can result in inefficient and
inappropriate discourse production.
A constellation of cognitive-linguistic disorders, either in isolation or in combination,
can contribute to observed differences in discourse production following RHD (see Tompkins,
Klepousniotou, & Gibbs-Scott, 2017 for a review). Cognition may be affected in one or more
areas of attention, memory, and executive functioning. Linguistic-related deficits including
referential communication (Chantraine, Joanette, & Ska, 1998), prosody (Baum & Dwivedi, 2003),
lexical semantics (Joanette, Goulet, & Hannequin, 1990), and figurative language (Lundgren,
Brownell, Cayer-Meade, Milione, & Kearns, 2011; Van Lancker & Kempler, 1987) can also
occur even when the basic building blocks of language are preserved (e.g., syntax, grammar,
and intelligibility).
Discourse is considered a point of intersection between language and cognition (Ylvisaker,
Szekeres, & Feeney, 2001). Thus, the co-occurrence of cognitive-linguistic deficits can contribute
to discourse that is content deprived (Joanette & Goulet, 1990), disinhibited, tangential, and
plagued with inappropriate comments and humor (Brownell & Martino, 1998; Klonoff, Sheperd,
O’Brien, Chiapello, & Hodak, 1990). Whereas some deficits associated with RHD may improve
over the course of the rehabilitation period (i.e., anosognosia and visual-spatial neglect), discourse
deficits may remain an unchanged (Blake, 2006) and debilitating consequence of RHD. Disruption
of overall quality of life related to interpersonal, social, and vocational adjustment is one potential
consequence of RHD; yet few, if any, referrals to speech-language pathology target improving
discourse production (Blake, Duffy, Tompkins, & Myers, 2003).
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Rationales for the lack of referrals specifically targeting discourse production deficits
following RHD are multifaceted and a detailed discussion extends beyond the scope of this article.
Reduced knowledge and understanding of communication behaviors by clinicians, researchers,
and medical practitioners (Blake et al., 2003; Douglas, 2016) alike, coupled with the heterogeneity
of resulting cognitive-communication disorders and discourse production differences, the absence
of agreed upon measures to aid in the identification of discourse production deficits (Tompkins,
Fassbinder, Lehman-Blake, & Baumgaertner, 2002), and lack of treatment protocols specific
to discourse production may factor into diminished referrals. Clinicians, however, can aid in
reconciling the discrepancy between rehabilitation services for and the existence of discourse
production deficits following RHD. Developing a reasonable expectation of possible differences
in the discourse production behaviors of adults with RHD as a basis of consideration during the
clinical screening process is a necessary first step in this reconciliation process.
The purpose of this article is to provide the clinician with a broad foundation of discourse
production behaviors that may be observed in adults with RHD. A brief discussion of discourse and
how it is represented in the RHD literature is followed by descriptions of possible communication
behaviors, discourse sampling techniques, and possible strategies for advancing the discourse
production literature, at the clinical level.
Discourse Production Representation
Discourse can be thought of as “language in use”wherein the language (e.g., spoken,
written, or signed) is larger than a sentence and serves to promote a specific action and meaning
in a real-world context (Cameron, 2001; Halliday, 1978, 1994; Martin & Ringham, 2000). Many
discourse genres can be subsumed under this definition, each varying in structure and content
of information. While discourse production deficits are duly noted in adults with RHD, studies
have primarily focused on narrative discourse processing (e.g., Bihrle, Brownell, Powelson, &
Gardner, 1986; Hough, 1990; Rehak, Kaplan, Weylman, Brownell, & Gardner, 1992; Roman,
Brownell, Potter, Seibold, & Gardner, 1987; Wapner, Hamby, & Gardner, 1981). It is not surprising
then, that narrative discourse production is emphasized to a greater extent in the published
literature of discourse production (e.g., Joanette & Goulet, 1990; Joanette, Goulet, Ska, &
Nespoulous, 1986; Sherratt & Bryan, 2012; Sherratt & Penn, 1990). Fewer published inquiries
exist that focus on procedural discourse production (e.g., Bartels-Tobin & Hinckley, 2005;
Sherratt & Penn, 1990; Ulatowska, Allard, & Chapman, 1990) and conversational discourse (e.g.,
Barnes & Armstrong, 2010; Brady, Mackenzie, & Armstrong, 2003; Hird & Kirshner, 2003; Kennedy,
2000; Kennedy, Strand, Edythe, Burton, & Peterson, 1994;).
Discourse production has been explored at two structural levels: (a) microstructure and
(b) macrostructure (see Table 1.). The microstructure of discourse involves the individual words,
clauses, sentences, and turns of talk, with respect to conversational discourse, and how each
entity relates to the other to achieve meaning (Glowalla & Colonius, 1982). The macrostructure of
discourse is the global topic, central message, or gist of the discourse (Myers, 1999; van Dijk, &
Kintsch, 1983).
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Effective discourse production is dependent on the successful organization and execution
of language at both the microstructure and macrostructure levels. Cohesive ties (e.g., conjunctions,
personal pronouns, and demonstrative pronouns), vocabulary complexity, and variability of
sentence structure with respect to sentence length, grammar, or use of past tense, for example,
are some aspects of discourse microstructure. Appropriate discourse microstructure facilitates a
clear discourse macrostructure. That is, decisions about word choice and sentence construction,
with respect to organization and complexity, have a direct bearing on the development of an overall
theme or gist of the discourse. Differences in discourse production in adults with RHD have been
realized to a greater extent at the macrostructural level (Delis, Wapner, Gardner, Moses, 1983;
Hough, 1990; Marini, Carlomagno, Caltagirone, & Nocentini, 2005) although some differences in
microstructure have been noted (Bartels-Tobin & Hinckley, 2005; Joanette et al., 1986; Kennedy
et al., 1994).
Narrative Discourse
Narrative discourse can be defined as a form of language use that describes a sequence
of events (either fictional or nonfictional), usually from the past, that are contingent on another.
Components of a narrative include the setting, a conflict or complication, a climax, and a resolution
(Ulatowska et al., 1990; van Dijk, 1977). Narrative discourse has been sampled by using a number
of visual stimuli including single page images capturing a complete story, multiple pages using
an illustrated children’s book, and framed drawings (i.e., comic strip like) depicting stories that are
either sequentially or non-sequentially arranged (see Table 2 for examples of visual stimuli used
in narrative discourse sampling).
Table 1. Examples of Macrostructure and Microstructure Discourse Measures Used in the RHD
Literature.
Macrostructure Microstructure
Measure Description Measure Description
Lexical
information
units (LIUs)
Content and function words that are
pragmatically, grammatically, and
phonologically appropriate for the
discourse (e.g., Marini, 2012; Marini
et al., 2005)
Total words Sum of total words(e.g., Joanette,
Goulet, Ska, & Nespoluous, 1986;
Sherratt & Penn, 1990)
Main
Concepts/
Steps
Established essential components of
the procedure (e.g., Bartels-Tobin &
Hinckley, 2005; Nicholas &
Brookshire, 1993)
Correct
Information
Units (CIU)
Words that are intelligible in context,
relevant and informative in relation
to stimulus used to elicit discourse
(e.g., Bartels-Tobin & Hinckley,
2005; Nicholas & Brookshire, 1993)
Topic
Skills/
Scenes
Measures of topic skills are variable.
Some studies focus on topic
coherence while others focus on
topic management. See cited
references for details (e.g., Brady,
Armstrong, & Mackenzie, 2003;
Brady, MacKenzie, & Armstrong,
2005; Kennedy, 2000)
T-units Minimal unit of a complete sentence
that contains one independent
clause and a connected dependent
clause (e.g., Joanette, Goulet, Ska, &
Nespoluous, 1986; Sherrat & Penn,
1990)
Turns of
talk
Operationally defined terms used
to describe the type of turn taken or
(e.g., Kennedy, Strand, Burton, &
Peterson, 1994; Minga & Lundgren,
2009; Minga, Lundgren, Brownell,
Cayer-Meade, & Spitzer, 2008)
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In general, adults with RHD are noted to produce narratives that are less informative
(Rivers & Love, 1980). Diminished information has been quantified by reduced complexity and
the exclusion of core propositions when telling the story using an eight-frame drawing depicting
the Cowboy Story (Joanette et al., 1986). Core propositions are defined as expected pieces of
information, as determined by the author’s narrative and at least 20% of the study participants.
Bartels-Tobin and Hinckley (2005) found that the narratives of adults with RHD were characterized
by the production of fewer main concepts and the omission of at least two main concepts when a
narrative was produced using a book depicting the story of Cinderella. Main concepts, similar to
core propositions, are defined as concepts present in a percentage of the control group transcripts.
In this instance, the main concepts were used by at least 66% of the control group transcripts.
Differences in the discourse microstructure may not distinguish the narratives of adults
with RHD. For example, narratives may contain just as many words (Joanette et al., 1986; Marini
et al., 2005) or have four times as many words (Sherratt & Penn, 1990) as controls. Narratives
are, however, distinguished by the complexity of the discourse. Reduced complexity may be
demonstrated by the use of empty phrases (Sherratt & Penn, 1990), fewer complex propositions
(Joanette et al., 1986), reduced adjective use (Joanette & Goulet, 1990), and reduced complete
information units (CIUs; Bartels-Tobin & Hinckley, 2005). Additional characteristics may include
difficulty with arranging sentences during the construction of narratives (Delis et al., 1983; Marini
et al., 2005) and an inability to select appropriate story and cartoon endings (Bihrle et al., 1986).
Procedural Discourse
Procedural discourse is used to tell an addressee how to do something. In this way, steps,
usually contingent on one another and chronologically organized, are provided that lead to a
specific goal (Ulatowska et al., 1990; Ulatowska, North, & Macaluso-Haynes, 1981). Successful
production of a procedure, like most discourse genres, requires one to be cognizant of background
knowledge with respect to circumstances of the discourse in use and the information needs of the
listener. Pertinent components of producing procedures include, at a minimum, the identification
of a problem or need, preparatory steps, and the selection of steps needed to successfully conduct
the procedure.
Examinations of procedural discourse in the RHD literature have taken a number of
sampling forms (see Table 3). In general, procedures are sampled in response to requests to describe,
explain, or instruct another person on the process for completing familiar activities of daily living.
Some studies elicit procedures by using the carrier phrase “Tell me how you would…” (Sherrat
& Bryan, 2012), while others simply ask for the process. In most instances the appropriateness of
a procedure is measured by the inclusion of essential steps (e.g., Bartels-Tobin & Hinckley, 2005;
McDonald, 2000). Essentials steps are those included in the procedure by more than half of
the control group (McDonald, 2000). This measure is similar to the core propositions and main
concepts used in the analysis of narrative discourse production.
Table 2. Examples of Visual Stimuli for Narrative Discourse Sampling.
Framed Drawings Single Image Books
The Cowboy Story (8 frames;
Joanette et al., 1986)
Cookie Theft (Goodglass
& Kaplan, 1983)
Cinderella (Bartels-Tobin &
Hinckley, 2005)
Bear and the Fly (19 frames;
Winter, 1976)
The Runaway (Rockwell,
1958)
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Procedural discourse performance following RHD may be similar to non-brain-damaged
comparison groups in terms of syntactic complexity, the inclusion of major procedural elements
or steps, and sequencing capabilities (Bartels-Tobin & Hinckley, 2005; McDonald, 2000; Roman
et al., 1987; Sherratt & Penn, 1990). Just as in narrative discourse production, differences
in procedural discourse production have been noted in terms of the informative quality of the
procedure. For example, Sherratt and Penn (1990) found that one adult with RHD produced
more words, incomplete utterances, and indefinite phrases than the non-brain-damaged control.
Other researchers have found that participants with RHD include more personalized or tangential
comments, jokes, opinions, and indefinite terms than non-brain-damaged controls (Gardner,
Brownell, Wapner, & Michelow, 1983; Roman et al., 1987).
Conversational Discourse
While examinations of procedural and narrative discourse are beneficial in furthering our
understanding of communication deficits following RHD, they are not representative of the one
form of communication that permeates all aspects of daily living: Conversation. Conversation
is a discursive, goal-driven, and locally-managed act (Nofsinger, 1991; Wardhaugh, 2006). In
conversation, information may be conceived, modified, and interpreted on a turn-by-turn basis.
Unlike narrative and procedural discourse, the end product is less predictable. This is largely
because effective conversation requires one to adhere to social rules (Clark, 1996; Sacks, Schegloff,
& Jefferson, 1974) that are based on cooperation, assumptions about and shared knowledge with
the conversational partners (Hird & Kirshner, 2003; Kennedy et al., 1994; Kennedy, 2000; Youse,
Gathof, Fields, Lobianco, Bush, & Noffsinger, 2011).
It has proven difficult to sample conversations in a manner that captures the naturalness
of the communicative encounter while controling for extraneous variables that may affect the
discourse production process. Conversational discourse sampling techniques employed in the
RHD literature have a range of structure. Semi-structured conversations and first-encounter
conversations are two elicitation strategies that may be particularly conducive to clinical practice.
Table 3. Procedural Discourse Sampling.
Purchasing
jacket
Teach
someone
to ride a
bike
Changing
tire
Restaurant
dining
Change
Lightbulb
Make
Sandwich
(favorite or
PBJ)
Replacing
glass
window
Bartels-Tobin
& Hinckley
(2005)
**
Brady,
Armstrong, &
MacKenzie
(2005)
**
Sherratt &
Penn (1991)
**
Roman,
Brownell,
Potter, &
Seibold (1987)
**
Sherratt &
Bryan (2012)
*** *
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A semi-structured conversation or a topic-centered interview (Ripich & Terrell, 1988) is
one sampling strategy used in the RHD literature. Elicitation of semi-structured conversations
may be accomplished if the non-brain-damaged conversational partner initiates a topic of
discussion using the carrier phrase, “Tell me about.”Topic foci of health, family, and daily living
are reported in the literature. Hird and Kirshner (2003) and Brady et al. (2003) used this technique
in their evaluation of conversational discourse in adults with RHD. Less structured sampling has
occurred with the use of first-encounter dyads (Kennedy et al., 1994). In this elicitation strategy,
adults with RHD are asked to ‘get to know’an unfamiliar person during a conversational exchange.
This strategy can be employed in any novel communication setting wherein the communication
partners are unfamiliar.
Investigations suggest that differences in conversational discourse following RHD are
(more often times than not) less obvious when compared to communication deficits following left
hemisphere brain damage. This is not surprising given that macrostructural differences (as
opposed to microstructural) are noted more often during other discourse production tasks. Findings
have resulted in a range of characterizations from laconic to verbose. This range of verbal output
may be related to the cognitive-linguistic idiosyncrasies and variability characteristic of adults
with RHD. Lack of discernment when considering topic choice, an apparent disinterest in
communication partners, and failure to adhere to turn-taking rules are among descriptions
commonly ascribed to the conversational discourse of adults with RHD (Brownell & Martino,
1998; Beeman & Chiarello, 1998; Chantraine et al., 1998; Joanette et al., 1990; Kennedy, 2000;
Myers, 1999; Tompkins, 1995). Some adults with RHD fail to adhere to cues to terminate the
conversation and maintain a topic (Kennedy, 2000), while others do not (Brady et al., 2003;
Kennedy et al., 1994). The resulting speech may consist of fewer requests for information, more
words per turn of talk, and more assertions of facts or opinions when compared to non-brain-
damaged participants (Kennedy et al., 1994; Minga & Lundgren, 2009). Such findings are
commensurate with descriptions of grammatically correct sentences which range from content
deficient to detail heavy, or the inclusion of broadly related but inappropriate information (Sherratt
& Bryan, 2012).
Advancing the Literature
Anecdotal descriptions of discourse behaviors have been useful in aiding clinicians in
their ability to discern differences in the communication of adults with RHD (Blake, 2010).
However, there is a growing need to advance our understanding of, and quantify differences
and changes in discourse production. Clinicians can contribute to this process in three specific
ways. First, clinicians can administer a set protocol of assessments for each RHD referral.
Consistency in assessment administration can serve as a basis of knowledge that may be compared
across patients and, if collaborating with others, clinical settings. A detailed list of possible
cognitive-linguistic assessments commonly used in the assessment of adults with RHD is
provided by Tompkins et al. (2017).
Second, clinicians can examine discourse production before and after skilled treatment.
There is a growing body of evidence-based treatments targeted to improve cognitive-linguistic
and comprehension-based deficits associated with RHD (i.e., Blake, Tompkins, Scharp, Meigh, &
Wambaugh, 2015; Cicerone et al., 2011; Tompkins, Scharp, Meigh, Blake, & Wambaugh, 2012).
Examining discourse production before and after implementing an established treatment approach
can provide invaluable information about the relationship between the quality of discourse
production and other areas of deficit.
The utility of this approach is highlighted by Minga et al. (2008) in their examination of
conversational discourse production of one person after participation in the Metaphor Training
Program (MTP; Lundgren et al., 2011). Briefly, the MTP is a 5-week, semi-structured intervention
targeted to improve the comprehension of novel metaphors. As part of the protocol, first-encounter
conversations were elicited before and after MTP participation. Each conversation was analyzed
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using the Discourse Contribution Measure (DCM; Minga & Lundgren, 2011), a measure consisting
of nine operationally defined parameters that describe the type of turn used to contribute to
a conversation. Findings showed that discourse production, at the conversational level, was
different after participation in the MTP. The participant appeared to take a more active role
in the conversation by contributing more questions, novel information, and topic appropriate
elaborations after completing the training program.
Lastly, clinicians may choose to participate in the systematic collection of discourse
samples and survivor demographics; thereby, contributing to a larger body of data. There are
at least two resources for doing this: (a) The RHDBank and (b) The Right Brain Stroke Research
Registry (RBSRR). The RHDBank, a new shared database extension of TalkBank, provides
an established protocol that clinicians can use to elicit discourse samples from adults with RHD
(Talk Bank, n.d.). Clinicians can access and use the RHD Discourse Protocol when treating
clients with RHD. Provided that proper institutional review board approval is received, clinicians
may also contribute samples to the database. The Right Brain Stroke Research Registry (RBSRR)
is the only known registry dedicated to RHD (a webpage is forthcoming, contact the author for
more information). The purpose of the registry is to identify adults 18 years and older with RHD
who are interested in research participation opportunities. To date, the registry has survivors
residing in five states. Registry participants comprise an accessible pool of possible research
participants for dedicated studies and the collection of demographic information needed to
determine incidence and prevalence of cognitive-communication related impairments in adults
with RHD. Clinicians may provide the registry information to adults with RHD so that they may
self-identify as a registry participant volunteer.
Conclusion
Understanding discourse production following RHD remains a needed area of research,
particularly as it relates to evidence-based assessment and treatment. Published articles focused
on discourse production following RHD are scant resulting in knowledge restricted to fairly
anecdotal descriptions of behaviors. Variability and inconsistency of measures and terminology
coupled with the threat of extraneous variables have undoubtedly contributed to the research
stagnancy and clinical challenge of determining the functional significance of communication
changes. Adults with RHD may have no difficulty with the construction of syntactically,
grammatically, and semantically congruent sentences, but can lack the ability to tie sentences
together in an appropriate, cohesive, and coherent fashion. Clinicians as researchers can serve to
advance the literature by delineating the relationship between nebulous clinical indicators and
functional discourse production behaviors (Weed, 2011; see Tompkins, Scott, & Scharp, 2008
for information about the clinician as an investigator) by choosing to administer the same
assessments, engaging in the systematic collection of discourse samples, and electing to examine
the discourse of adults with RHD before and after skilled treatment. Collectively, these efforts can
generate large samples of data that may foster comparisons of information across clinical settings
and advance the RHD discourse production literature.
References
Barnes, S., & Armstrong, E. (2010). Conversation after right hemisphere brain damage: Motivations for
applying conversation analysis. Clinical Linguistics & Phonetics, 24(1), 55–69.
Bartels-Tobin, L. R., & Hinckley, J. J. (2005). Cognition and discourse production in right hemisphere
disorder. Journal of Neurolinguistics, 18, 461–477.
Baum, S., & Dwivedi, V. (2003). Sensitivity to prosodic structure in left- and right-hemisphere-damaged
individuals. Brain and Language, 87, 278–289.
Beeman, M., & Chiarello, C. (1998). Right hemisphere language comprehension: Perspectives from cognitive
neuroscience. Mahwah, N.J: L. Erlbaum Associates.
102
Downloaded From: http://perspectives.pubs.asha.org/ by a ReadCube User on 07/13/2016
Terms of Use: http://pubs.asha.org/ss/rights_and_permissions.aspx
Bihrle, A. M., Brownell, H. H., Powelson, J. A., & Gardner, H. (1986). Comprehension of humorous and
nonhumorous materials by left and right brain-damaged patients. Brain and Cognition, 5(4), 399–411.
Blake, M. L. (2006). Clinical relevance of discourse characteristics after right hemisphere brain damage.
American Journal of Speech-Language Pathology, 15(3), 255–267.
Blake, M. L., Duffy, J. R., Tompkins, C. A., & Myers, P. S. (2003). Right hemisphere syndrome is in the eye
of the beholder. Aphasiology, 17, 423–432.
Blake, M. L. (2010). Communication deficits associated with right hemisphere brain damage. In J. S. Damico,
N. Muller, & M. J. Ball (Eds.), The Handbook of Language and Speech Disorders, Malden, MA: Wiley-Blackwell.
Blake, M. L., Tompkins, C. A., Scharp, V. L., Meigh, K. M., & Wambaugh, J. (2015). Contextual Constraint
Treatment for coarse coding deficit in adults with right hemisphere brain damage: Generalisation to
narrative discourse comprehension. Neuropsychological rehabilitation, 25(1), 15–52.
Brady, M., Mackenzie, C., & Armstrong, L. (2003). Topic use following right hemisphere brain damage
during three semi-structured conversational discourse samples. Aphasiology, 17, 881–904.
Brownell, H. H., & Martino, G. (1998). Deficits in inference and social cognition: The effects of right
hemisphere brain damage on discourse. In M. Beeman & C. Chiarello (Eds.), Right hemisphere language
comprehension: Perspectives from cognitive neuroscience (pp. 309–328). Mahwah, NJ: Erlbaum.
Cameron, D. (2001). Working with spoken discourse. SAGE Publications Ltd.
Clark, H. H. (1996). Using language. Cambridge: Cambridge University Press.
Chantraine, Y., Joanette, Y., & Ska, B. (1998). Conversational abilities in patients with right hemisphere
damage. Journal of Neurolinguistics, 11(1-2), 21–32.
Cicerone, K. D., Langebahn, D. M., Braden, C., Malec, J. F., Kalmar, K., Fraas, M., ... Ashman, T. (2011).
Evidence-based cognitive rehabilitation: Updated review of the literature from 2003-2008. Archives of
Physical Medicine and Rehabilitation, 92(4), 519–530.
Delis, D., Wapner, W., Gardner, H., & Moses, J. (1983). The contribution of the right hemisphere to the
organization of paragraphs. Cortex, 19, 43–50.
Douglas, N. F. (2016). Organizational context associated with time spent evaluating language and cognitive-
communicative impairments in skilled nursing facilities: Survey results within an implementation science
framework. Journal Communication Disorders, 60, 1–13.
Gardner, H., Brownell, H. H., Wapner, W., & Michelow, D. (1983). Missing the point: The role of the right
hemisphere in the processing of complex linguistic materials. In E. Perecman (Ed.), Cognitive processing in
the right hemisphere. New York, NY: Academic Press.
Glowalla, U., & Colonius, H. (1982). Toward a model of macrostructure search. In A. Flammer & W. Kintsch
(Hrsg.), Discourse Processing (pp. 111–123). Amsterdam: North Holland.
Goodglass, H., & Kaplan, E. (1983). Boston diagnostic aphasia examination (BDAE). Philadelphia, PA: Lea
and Febiger.
Halliday, M. A. K. (1978). Language as social semiotic: The social interpretation of language and meaning.
London, Edward Arnold and Baltimore: University Park Press.
Halliday, M. A. K. (1994). An introduction to functional grammar (2nd ed.). London: Edward Arnold.
Hird, K., & Kirshner, K. (2003). The effect of right cerebral hemisphere damage on collaborative planning in
conversation: An analysis of intentional structure. Clinical Linguistics and Phonetics, 17(4-5), 309–315.
Hough, M. S. (1990). Narrative comprehension in adults with right and left hemisphere brain-damage:
Theme organization. Brain and language, 38(2), 253–277.
Joanette, Y., & Goulet, P. (1990). Narrative discourse in right-brain-damaged right-handers. In Y. Joanette,
& H. Brownell (Eds.), Discourse ability and brain damage. New York: Springer-Verlag.
Joanette, Y., Goulet, P., & Hannequin, D. (1990). Right hemisphere and verbal communication. New York:
Springer-Verlag.
Joanette, Y., Goulet, P., Ska, B., & Nespoulous, J. L. (1986). Informative content of narrative discourse in
right-brain-damaged right-handers. Brain and Language, 29(1), 81–105.
Kennedy, M. (2000). Topic scenes in conversations with adults with right hemisphere brain damage. American
Journal of Speech-Language Pathology, 9, 72–86.
103
Downloaded From: http://perspectives.pubs.asha.org/ by a ReadCube User on 07/13/2016
Terms of Use: http://pubs.asha.org/ss/rights_and_permissions.aspx
Kennedy, M., Strand, W., Edythe, A., Burton, W., & Peterson, C. (1994). Analysis of first-encounter
conversations of right-hemisphere-damaged adults. Clinical Aphasiology, 22, 67–80.
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.
Lundgren, K., Brownell, H., Cayer-Meade, C., Milione, J., & Kearns, K. (2011). Treating metaphor interpretation
deficits subsequent to right hemisphere brain damage: Preliminary results. Aphasiology, 25(4), 456–474.
Marini, A., Carlomagno, S., Caltagirone, C., & Nocentini, U. (2005). The role of the right hemisphere in the
organization of complex textual structures. Brain and Language, 93, 46–54.
Marini, A. (2012). Characteristics of narrative discourse processing after damage to the right hemisphere.
Seminars in Speech and Language, 33(1), 68–78.
Martin, B., & Ringham, F. (2000). Dictionary of semiotics. London: Cassell.
McDonald, S. (2000). Exploring the cognitive basis of right hemisphere pragmatic language disorder. Brain
and Language, 75(1), 82–107.
Minga, J., Lundgren, K., Brownell, H., Cayer-Meade, C., & Spitzer, J. (2008). Conversational discourse
before and after metaphor comprehension training: A pilot study. Poster Presentation. American Speech-
Language and Hearing Association Annual Convention, Chicago, IL.
Minga, J., & Lundgren, K. (2009). An analysis of discourse production and working memory in one individual
with right hemisphere brain damage (RHD). Poster Presentation. The International Neuropsychological
Society’s Annual Conference, Atlanta, GA.
Minga, J., & Lundgren, K. (2011). A tool assessing conversational discourse in right hemisphere brain
damage. Poster Presentation. American Speech-Language and Hearing Association Annual Convention.
San Diego, CA.
Myers, P. S. (1999). Right hemisphere damage: Disorders of communication and cognition. San Diego, CA:
Singular Publishing Group.
Nicholas, L. E., & Brookshire, R. H. (1993). A system for quantifying the informativeness and efficiency of the
connected speech of adults with aphasia. Journal of Speech, Language, and Hearing Research, 36, 338–350.
Nofsinger, R. E. (1991). Everyday Conversation. Newbury Park, California: Sage Publishing, Inc.
Rehak, A., Kaplan, J. A., Weylman, S. T., Kelly, B., Brownell, H. H., & Gardner, H. (1992). Story processing
in right-hemisphere brain-damaged patients. Brain and Language, 42(3), 320–336.
Ripich, D. N., & Terrell, B. Y. (1988). Patterns of discourse cohesion and coherence in Alzheimer’s disease.
Journal of Speech and Hearing Disorders, 53(1), 8–15.
Rivers, D. L., & Love, R. J. (1980). Language performance on visual processing tasks in right hemisphere
lesion cases. Brain and Language, 10(2), 348–366.
Rockwell, N. (1958). The runaway. The Post.
Roman, M., Brownell, H. H., Potter, H. H., Seibold, M. S., & Gardner, H. (1987). Script knowledge in right
hemisphere damaged and in normal elderly adults. Brain and Language, 31, 151–170.
Sacks, H., Schegloff, E. A., & Jefferson, G. (1974). A simplest systematics for the organization of turn-taking
for conversation. Language, 50, 696–735.
Sherratt, S., & Bryan, K. (2012). Discourse production after right brain damage: Gaining a comprehensive
picture using a multi-level processing model. Journal of Neurostructures, 25(4), 213–239.
Sherratt, S. M., & Penn, C. (1990). Discourse in a right-hemisphere brain-damaged subject. Aphasiology, 4,
539–560.
Talk Bank. (n.d.). Retrieved from https://talkbank.org/RHDBank/
Tompkins, C. A. (1995). Right hemisphere communication disorders: Theory and management. San Diego,
CA: Singular Publishing Group.
Tompkins, C. A., Fassbinder, W., Lehman-Blake, M. T., & Baumgaertner, A. (2002). The nature and
implicationsofrighthemispherelanguagedisorders:Issuesinsearchofanswers.InA.Hillis(Ed.),
Handbook of adult language disorders: Integrating cognitive neuropsychology, neurology, and rehabilitation
(pp. 429–448). Psychology Press.
104
Downloaded From: http://perspectives.pubs.asha.org/ by a ReadCube User on 07/13/2016
Terms of Use: http://pubs.asha.org/ss/rights_and_permissions.aspx
Tompkins, C. A., Klepousniotou, E., & Gibbs-Scott, A. (2017). Nature and assessment of right hemisphere
communication disorders. In I. Papathanasiou, P. Coppens, & C. Potagas (Eds.), Aphasia and related
neurogenic communication disorders. Sudbury, MA: Jones and Bartlett.
Tompkins, C. A., Scharp, V. L., Meigh, K. M., Blake, M. L., & Wambaugh, J. (2012). Generalization of a
novel implicit treatment for coarse coding deficit in right hemisphere brain damage: A single-participant
experiment. Aphasiology, 26(5), 689–708.
Tompkins, C.A., Scott, A., & Scharp, V. L. (2008). Research principles for the clinician. In R. Chapey (Ed.),
Language intervention strategies in adult aphasia (5th ed., pp. 163–185). Baltimore: Lippincott Williams &
Wilkins.
Ulatowska, H., Allard, L., & Chapman, S. (1990). Narrative and procedural discourse in aphasia. In
Y. Joanette and H. Brownell (Eds.), Discourse ability and brain damage (pp. 171–190). New York, NY:
Springer-Verlag.
Ulatowska, H. K., North, A. J., & Macaluso-Haynes, S. (1981). Production of narrative and procedural
discourse in aphasia. Brain and Language, 13, 345–371.
Van Dijk, T. A. (1977). Semantic macro-structures and knowledge frames in discourse comprehension. In
M. A. Just & P. Carpenter (Eds.), Cognitive processes in comprehension (pp. 3–32). Hillsdale, NJ: Lawrence
Erlbaum Associates Inc.
Van Dijk, T. A., & Kintsch, W. (1983). Strategies of discourse comprehension. New York: Academic Press.
Van Lancker, D. R., & Kempler, D. (1987). Comprehension of familiar phrases by left- but not right
hemisphere damaged patients. Brain and Language, 32(2), 265–277.
Wapner, W., Hamby, S., & Gardner, H. (1981). The role of the right hemisphere in the apprehension of
complex linguistic materials. Brain and Language, 14, 15–32.
Wardhaugh, R. (2006). An introduction to sociolinguistics, Fifth Edition. Blackwell Publishing: Australia.
Weed, E. (2011). What’s left to learn about the right hemisphere and pragmatic impairment? Aphasiology,
25(8), 872–889.
Winter, P. (1976). The Bear & the Fly. New York: Crown Publishers.
Ylvisaker, M., Szekeres, S. F., & Feeney, T. (2001). Communication disorders associated with traumatic
brain injury. In R. Chapey (Ed.). Language intervention strategies in aphasia and related neurogenic
communication disorders (745–800). Philadelphia: Lippincott, Williams & Wilkins.
Youse, K. M., Gathof, M., Fields, R. D., Lobianco, T. F., Bush, H. M., & Noffsinger, J. T. (2011). Conversational
discourse analysis procedures: A comparison of two paradigms. Aphasiology, 25, 106–118.
History:
Received February 04, 2016
Revised May 20, 2016
Accepted May 20, 2016
doi:10.1044/persp1.SIG2.96
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