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

2. 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).

3. 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

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

5. Continued Shape behaviors Fade prompts
Provide reinforcement and feedback immediately

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

7. 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?

8. 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

9. 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

10. 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)

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

12. 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)

13. 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

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