Implicit Treatment of Underlying Comprehension Processes Improves Narrative Comprehension in Right Hemisphere Brain Damage

Tompkins, Connie A. and Blake, Margaret T. and L Scharp, Victoria and Meigh, Kimberly M. and Wambaugh, Julie L. (2013) Implicit Treatment of Underlying Comprehension Processes Improves Narrative Comprehension in Right Hemisphere Brain Damage. [Clinical Aphasiology Paper]

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Abstract

Language comprehension deficits in adults with focal right hemisphere brain damage (RHD) can cause considerable social handicap. To date, however, treatment for these deficits remains almost entirely untested. This abstract reports an investigation of whether Contextual Constraint Treatment (CCT) -- a novel, implicit, stimulation-facilitation treatment for language comprehension processes1,2 -- can yield generalized gains to measures of discourse comprehension in adults with RHD. The focus of CCT is motivated by two major accounts of typical RHD language comprehension problems: that they are due to coarse coding or suppression deficits. Coarse coding (CC) activates wide-ranging aspects of word meaning independent of surrounding context. In RHD, CC deficits impair processing of distant meanings/features of words (e.g., “rotten” as a feature of “apple”)3. A normal suppression (SUPP) process reduces mental activation of concepts that become less relevant to a current context. RHD SUPP impairment is indexed by prolonged processing interference from contextually-inappropriate interpretations (e.g., the “ink” meaning of the word “pen,” in the sentence “He built a pen”)4,5. CC and SUPP are partially domain-general language comprehension processes. For example, both predict aspects of discourse comprehension and are hypothesized to underpin figurative language comprehension; SUPP is important for resolving lexical and inferential ambiguities; and CC is involved in processing both literal lexical items and phrasal metaphors1,2,6. Thus, treatment that improves CC and SUPP processes may hold promise for improving a broad range of communicative outcomes. CCT is novel in aiming to facilitate comprehension processes implicitly, through contextual prestimulation. Adults with RHD who perform well on implicit assessments of language processing often have difficulty on metalinguistic assessments of the same operations2. Thus we implemented this approach to avoid confounding treatment of impaired processes with irrelevant, and potentially difficult, task demands.

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